Submission to Hamilton City Council (HCC) Regarding Water Fluoridation

Home , Kapiti Coast District, Napier City Council, Rangitikei District

Submission No: 1064

Submission to Hamilton City Council (HCC) regarding Water Fluoridation.

Greg Oosterbaan, 6 Howell Avenue, Hamilton.

Ph 0273052439

Email [email protected]

31stMarch 2013

Submission No: 1064

Contents. 4 – 12 Personal presentation

Appendix

13 What are they fluoridating with? From FANNZ website

16 NZ - Fluoridation status by council From FANNZ website

21 HYDROFLUOROSILICIC ACID AND WATER FLUORIDATION (The Process of Production)

http://nzic.org.nz/ChemProcesses/production/1C.pdf

24 Material Safety Data Sheet - SODIUM FLUORIDE

http://www.fannz.org.nz/pdfs/Sodium%20fluoride%20ORICA.pdf

29 Studies on Tooth Decay Rates After Water Fluoridation Is Stopped

Fluoride Action Network | February 2001

31 Supplementary submission to the Inquiry into how to prevent child abuse and improve children's health outcomes Katherine Smith

38 FLUOROSIS

40 Dental Fluorosis Incidence in New Zealand

Submission No: 1064

44 Fluoride Is Not an Essential Nutrient

Fluoride Action Network | August 2012 | By Michael Connett

46 Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries

F.A.N. | July 2012 | By Michael Connett

51 World Health Organisation Figures statistics on dental health of 12 year olds.

53 The Hastings Fluoridation Experiment

55 The Hastings Fluoridation Experiment: Science or Swindle?

By John Colquhoun and Robert Mann (http://exacteditions.theecologist.org/exact/browse/307/308/5395/3/21)

69 Why I Changed My Mind About Water Fluoridation

John Colquhoun

83 Fluoride & Intelligence: The 36 Studies

Fluoride Action Network | By Michael Connett& Tara Blank, PhD | UPDATED December 9, 2012

114 (New Zealand) Institute of Directors. (IoD)

https://www.iod.org.nz/

114 http://www.parliament.nz/en- NZ/PB/Legislation/Bills/b/c/8/00DBHOH_BILL11034_1-Natural-Health- and-Supplementary-Products-Bill.htm

115 http://en.wikipedia.org/wiki/Nuclear_and_radiation_accidents

Nuclear and radiation accidents

From Wikipedia.

Submission No: 1064

Water Fluoridation – My Submission Against the Practice.

Many of the references against water fluoridation are to be found on FANNZ and FAN websites and are likely to be repeated through these submissions, including this presentation. This does not detract from the importance and authenticity of these references.

I have tried to be as accurate and comprehensive as possible but must respect the need to be as concise as possible, in respect of the mammoth amount of study which you must do related to this subject.

These first few pages are my discussion around the many references which I have included and are an expression of my own, personal opinion as a concerned parent and resident of Hamilton city.

It is recognized that you strive to do your best in your elected role as a Hamilton City Council (HCC) councilor.

One of my basic human rights is the right to life. Without water (H2O), “Life” is impossible - water is a vital nutrient. I have a basic human right to water (H2O) and whatever minerals are present at their normal level, for that natural environment. I pay local authority rates and this local authority is charged with providing me, and all other residents of HCC catchment, with water. If there is a substance added, which I wish to avoid, Hamilton City Council (HCC) has a responsibility to provide me with a suitable filtration system, to remove any supplements which I (and my family members) wish to avoid – or to not add the “supplement” in the first place.

I have a basic human right to freedom of choice. I choose to not consume fluoridated water (beyond the naturally-occurring levels), whether pharmaceutical or industrial grade. Fluoride is not even a necessary nutrient - water is.

So as to not violate my basic human rights, HCC has a legal, moral and ethical duty to provide me (and all other residents who freely choose to not consume added fluoride) with water which does not have supplemented fluoride. Presently, my human rights are being violated – regarding water fluoridation. I ask that this practice is terminated.

Submission No: 1064

The New Zealand Institute of Directors (IoD) is a well-respected organisation.

The Institute’s 2012 publication, “The Four Pillars of Governance Best Practice for New Zealand Governors”, is a guide for it’s members. In the publication (page 87-) the issue of ethics is discussed. This concerns the different values which people hold and the need to respect other people’s values, wishes, opinions and freedom of choice.

It is crucial that the decision regarding water fluoridation is based on ethical values and respect for freedom of choice – an internationally respected basic human right which must be upheld in a democratic society.

Waikato region.

In our Waikato District, the local authorities of Hauraki, Matamata-Piako, Otorohanga, Waitomo and Waipa do not fluoridate their public water supply.

I am not aware of any sound scientific evidence showing significantly higher levels of dental caries in these un-fluoridated localities, relative to Hamilton which has been fluoridated. There are a number of data comparisons but these, I believe, are not standardized and are very subjective and would therefore be scientifically invalid. Any research data or data analysis must be validated to a standard where any report is acceptable for publication in an appropriate international scientific journal.

There are no bus-loads of dentists commuting to these outlying towns from Hamilton.

There are no unemployed dentists in Hamilton.

There are dental caries amongst the young residents of Hamilton.

Honest consideration of the above will result in the conclusion that adding fluoride to Hamilton’s water supply does not endow magical powers of dental health on the consumers. Indeed there is ample, valid scientific evidence of the opposite.

A growing list of Local Authorities worldwide (including New Zealand) are reversing the practice based on similar information as you receive – from health “authorities” and also those who present a sound, scientifically-supported argument in opposition. Also, please note that “authority” is in the legislative sense and does not necessarily guarantee “authenticity”.

Submission No: 1064

Privy Council (1963) “the addition of fluoride adds no impurity and the water remains not only water but pure water and becomes greatly improved and still natural water containing no foreign elements”

This decision is fifty years old and obviously must be revisited, based on comprehensive research in the interim.

Hydrofluorosilicic acid (H2SiF6) is the form of fluoride delivered in the Hamilton water supply. This is an inorganic compound and a bi-product of the fertiliser industry and is, I believe, a “foreign element”.

Submission No: 1064

From Waikato DHB website – public access.

Who has water fluoridation currently?

“Over 300 million people in 39 countries have access to fluoridated drinking water. These include Australia, Canada, Ireland, Israel, Singapore, Spain, the United Kingdom, and the United States”.

In contrast with the above quote from the DHB website, the vast majority of the world does not have added fluoride to the water supply. In Europe, approximately 97% is not fluoridated. I am not aware of any country where there is public protest to have fluoride added to the public water supply. The only public protest which I am aware of is people resisting enforced fluoridation. For more robust data of the global situation, see the WHO research results in the appendix.

Statement of Waikato DHB position

(WDHB) “Support further research into the benefits and potential risks of water fluoridation, and into appropriate alternatives to water fluoridation in communities where fluoridation is not feasible”.

What internationally referenced, scientifically valid (and externally validated) research has Waikato DHB (WDHB) engaged in to study the safety and effectiveness of water fluoridation? For example, a very valid project would be a meta-analysis to scientifically challenge and disprove the research presented on FANNZ website and Dr. Paul Connett’s publications. Has such a project been conducted and what are the results?

Has WDHB supported the case for water fluoridation with evidence which refutes the case presented against water fluoridation? Have the presenters of the case against water fluoridation supported their case with evidence which refutes the case for water fluoridation?

Provision of objective support (not simplistic, un-supported comment) against opposition presentation is a valid approach.

Submission No: 1064

I contend that Fluoride, in the form of Hydrofluorosilicic acid (H2SiF6), is being delivered to the whole population, as a supplement (“natural levels are being topped up” [i.e. supplemented] – WDHB web site), without individual medical prescription but on the authority of and promotion by medical staff on MoH and DHB payroll.

See the NZ Government Natural-Health-and-Supplementary-Products-Bill. Is the practice of water fluoridation as a supplement, as is my contention, addressed in this bill – either directly or by implication?

The diversity of our population in age, size, weight, metabolic rate, physiological capacity, health status, daily work and recreation tasks, etc dictates that there is a vast spread of water consumption between people and individual dose of added fluoride is also broad and not controllable.

There is individualised dose of prescription medicines / supplements to multitudes of people - the individuality is respected and negative consequences are monitored for. This is not so for the health supplement Fluoride.

Hydrofluorosilicic acid (H2SiF6) is the form of fluoride delivered in the Hamilton water supply. This is an inorganic compound and a bi-product of the fertiliser industry.

Does Hydrofluorosilicic acid (H2SiF6) break down in water (to become another, organic compound) or remain in it’s inorganic form? I am not fully familiar with the chemistry of the solutions involved but the information can be requested from authoritative scientists – representing cases for and against water fluoridation. It would be important to clarify the bioavailability and human bio- safety of ingested Hydrofluorosilicic acid (H2SiF6)

I did a web search for Hydrofluorosilicic acid (H2SiF6) on NZ Parliament web site (ttp://www.parliament.nz/en-NZ) but found no results. It is therefore likely that little, if any, study has been conducted into the human bio-safety of this inorganic compound (if ingested regularly over many years) which is added to Hamilton water supply, as a dietary / nutritional supplement.

Submission No: 1064

“Supplementary submission to the (NZ Government) Inquiry into how to prevent child abuse and improve children's health outcomes” by Katherine Smith presents excellent support against fluoridation – see Appendix

In her submission, Kathryn Smith presents strong, referenced evidence that added fluoride increases the risk of ;

Down Syndrome,

anaemia in pregnancy,

premature labour,

infant mortality and

reduced intelligence in children.

My opinion, based on study of objective and scientifically-validated information, that water fluoridation is ineffective and unsafe is well supported and referenced byFANNZ and Fluoridation Free New Zealand(and other opponents) and I refer you to their research data, rather than add the same references to this document. I simply add my support to the other presentations in opposition to water fluoridation, and to their references.

Opposition presentation will also include evidenced information for the challenges to supporters of fluoridation – The York Report, the Hastings/Napier and Auckland studies, etc. Please also accept my support of those references.

Submission No: 1064

We’re all different.

We’re all different – so don’t treat us all the same.

Each resident is a unique individual with different tolerances for substances which we ingest. We all have the capacity for reasonable stresses whether that be work pace, sleep deprivation, dietary fat / sugar, air pollution or ingested toxins. When our exposure to external stresses is prolonged, our bodies begin to express “disease”. In the “health” sector, these are what are called “preventable conditions”.

Humans, as well as all other animals, have a capacity for health, given the right environment. Human ill-health originates external to the sufferer. Also, people become ill from excess, not lack – except in very, very rare circumstances.

We need a reasonable amount of what is positive but, in excess, this has negative impact. Excess physical effort can cause stroke, heart attack or physical injury. Excess sunlight can cause melanoma. Excess fat-soluble supplements can cause liver injury. Excess heavy metals (eg mercury or aluminium) in our food or water can cause liver or nerve injury. Excess Fluoride can cause bone and nerve, injury – well referenced.

All health-conscious people are doing their best to minimise exposure to these stressors – workplace stress, sunburn, pesticide residues on our food, heavy metals in our sea fish, etc.

HCC, along with all other local authorities, puts much effort into reducing the amount of toxins in our water supply, and then add Hydrofluorosilicic acid – go figure!

The annual dollar cost of Hydrofluorosilicic acid is reputed to be $40,000. To this must be added the monitoring probes and pumps plus the maintenance and replacement costs. I believe that these costs are not insignificant. Add to this the labour cost per hour for monitoring, maintaining and replacing the machinery, along

Submission No: 1064

with the cost per hour of responding to alarms, if there is equipment malfunction and the acid is being added at an excessive rate.

Does HCC have an emergency plan if the equipment goes faulty and excessive levels of Hydrofluorosilicic acid are added to our public water supply? Yes, equipment does go faulty and yes, it could happen to us. The odds are low but so were the odds of nuclear accidents at;

Sellafield, Cumberland, United Kingdom

Three Mile Island, Pennsylvania, United States

Lucens reactor, Vaud, Switzerland

Chernobyl, Ukrainian SSR

Fukui Prefecture, Japan,Etc

To date there have been 99 accidents at nuclear power plants with safety standards well in advance of HCC fluoride monitoring equipment, etc. I am offering an extreme example but the same principles apply – even well-maintained equipment fails and there is harm to humans, animals, birds and fish and the extended environment. We don’t want plant failure in Hamilton, related to fluoridation, but the risk exists. Is there an accompanying plan?

Humans err – this is a fact of life. If we must err, let it be on the side of caution. This is particularly true if the potential negative includes human harm.

We all know that the major issue with dental caries in children is excess of lolly- sucking, soft drink swilling, chocolate chewing, pie eating as well as poor dental hygiene. Please don’t add a known poison to my water to solve that problem.

If this were a legal hearing, “Water Fluoridation” (the accused) has not been proven beyond reasonable doubt to be effective in reducing dental caries. Equally, “Water Fluoridation” (the accused) has not been proven beyond reasonable doubt to be safe for all of our residents.

You were elected into this position of influence and you strive to do your best in your role as a HCC councillor. These challenging decisions arise not too infrequently.

When making these important decisions, we use the brain, heart and gut. The brain will analyse the differing technical information, the heart-felt desire will strive for

Submission No: 1064

positive influence on Hamilton residents and the gut feeling will let you know if it

“feels right” to add Hydrofluorosilicic acid (H2SiF6) to the water supply.

My gut feeling is that adding an inorganic compound – an acid by-product of the fertiliser industry – to our drinking water doesn’t feel right. What is your gut feeling?

Thank you for your consideration of my submission against continued water fluoridation of Hamilton’s drinking water.

The views expressed are my own, personal views and opinions as I strive to have the best possible environment for all of us.

It’s a balance between doing good and avoiding harm. In this instance, I believe, it’s best to ensure that we avoid harm. That is what has been decided in many such local authority debates around the country and the rest of the world.

Greg Oosterbaan

31 March 2013

Submission No: 1064

APPENDIX.

What are they fluoridating with?

From FANNZ website

Help us complete this list by contacting your local council or water treatment facility and finding out: 1. which compound is used to fluoridate your water; 2. the target dose of fluoride; 3. the annual cost of operation (materials, training, equipment maintenance, etc.); 4. the supplier (company and country); 5. chemical composition, including levels of known contaminants.

Materials Safety data:

Hydrofluorosilicic acid (H2SiF6)

Sodium fluorosilicate (Na2SiF6) Sodium fluoride (NaF)

Click on location hyperlinks (where available) for more details.

Pukekohe

Location Sodium Sodium Hydrofluorosilicic Target F Annual Supplier

fluorosilicate fluoride acid (H2SiF6) dose cost

(Na2SiF6) (NaF) (mg/L)

Auckland x Orica

Balclutha x 0.85 $15,000 Kauri NZ

Dunedin x 0.85 $38,154 DC Rosser Ltd, importing

Na2SiF6 from Prayon

Submission No: 1064

(Belgium)

Gisborne x 0.80 $14,000 Orica

Greater x x 0.85 $182,000 Na2SiF6 from Wellington (varies + Consolidated between $80,000 Chemical 0.7 - 1.0) training Company costs Australia,

H2SiF6 from Orica (NZ)

Kapiti x 0.7 - 1.0 $13,213 Orica (importing

Na2SiF6 from India)

Hamilton x 0.7 - $40,000 Orica

0.8ppm

Hastings x 0.9 50c per Orica person

Hawera, x $2,000 Orica Normanby, Okaiawa, Ohawe

Masterton x 0.8 Orica

New x 0.7 $35,000 Orica Plymouth

Palmerston 0.8ppm $42,000 Orica North

Pukekohe x 0.8 - 1.0 $5,000- Orica $6,000

Taumarunui x $6,500 Orica

Submission No: 1064

Taupo x x 0.6 - 0.8 DC Rosser Ltd supplies

Na2SiF6, Orica

supplies H2SiF6 (from 2012- 2013, will be

Orica H2SiF6 exclusively)

Thames x 0.8 $2,500 Orica

Tokorua x (18% in undiluted $5,000 Orica form)

Whakatane, x 0.7 - 1.0 $10,300 Orica Ohope

Submission No: 1064

NZ - Fluoridation status by council

North Island

Northland

Far North District Council no (Kaitaia, Kaikohe stopped 31st March 09)

Kaipara District Council no

Whangarei District Council no

Auckland Super City yes (except Onehunga)

Waikato

Hamilton City Council yes

Hauraki District Council no

Matamata-Piako District Council no

Otorohanga District Council no

South Waikato District Council yes, but only Tokoroa

Thames-Coromandel District Council yes

Waikato District Council yes

Waipa District Council no

Waitomo District Council no

Bay of Plenty

Submission No: 1064

Kawerau District Council no

Opotiki District Council no

Rotorua District Council no

Taupo District Council yes

Tauranga City Council no

Western Bay of Plenty District Council no

Whakatane District Council yes

Taranaki

New Plymouth District Council no (stopped October 2011)

South Taranaki District Council yes

Stratford District Council yes

Gisborne

Gisborne District Council yes

Hawke's Bay

Central Hawke's Bay District Council no (stopped September 2012)

Hastings District Council yes

Napier City Council no

Wairoa District Council no

Wellington

Carterton District Council no

Submission No: 1064

Hutt City Council yes

Kapiti Coast District Council yes

Masterton District Council yes

Porirua City Council yes

South Wairarapa District Council no

Upper Hutt City Council yes

Wellington City Council yes

Manawatu-Wanganui

Horowhenua District Council no

Manawatu District Council yes, but only Feilding

Palmerston North City Council yes

Rangitikei District Council no

Ruapehu District Council no (stopped June 2011)

Tararua District Council no

Wanganui District Council no

South Island

Tasman

Tasman District Council no

Nelson

Nelson City Council no

Submission No: 1064

Marlborough

Marlborough District Council no

West Coast

Buller District Council no

Grey District Council no

Westland District Council no

Canterbury

Ashburton District Council yes - but only Methven

Christchurch City Council no

Hurunui District Council no

Kaikoura District Council no

Mackenzie District Council no

Selwyn District Council no

Timaru District Council no

Waimakariri District Council no

Waimate District Council no

Chatham Islands

Chatham Islands Council no

Otago

no - but have agreed (2102) to start Central Otago District Council fluoridating Ranfurly

Submission No: 1064

yes - Milton, Kaitangata and Tapanui only Clutha District Council started in 2011

Dunedin City Council yes

Queenstown-Lakes District Council no

Waitaki District Council no

Southland

Gore District Council no

Invercargill City Council yes

Southland District Council no

Total

Total number of councils 67

23 (if we count Ashburton District - only Total fluoridating small town of

Methven)

Submission No: 1064

http://nzic.org.nz/ChemProcesses/production/1C.pdf HYDROFLUOROSILICIC ACID AND WATER FLUORIDATION

Hydrofluorosilicic acid m anufact ure can be viewed as a t wo-st ep process, although in reality it is carried out in four steps to ensure that the right concentration of acid is obtained.

Step 1 - Production of SiF4 Th e superphosphate production process results in the evolution of carbon dioxide, steam and SiF4. Th i s Si F 4 is an environmental pollutant and so is removed from the gas stream and used to produce fluorosilicic acid.

Step 2 - Hydrolysis of SiF4 Th e Si F4 is removed from the gas stream by contacting the gas with water droplets. This water hydrolyses the SiF4 as f o llo w s: 3 Si F4 + 2H2O → 2H2Si F6 + Si O2 The resultant hydrofluorosilicic acid (H2Si F 6) is used for fluoridating drinking water.

INTRODUCTION In many cities in the western world, drinking water is fluoridated to help prevent people.s teeth from decaying. Fluorine achieves this by replacing hydroxyapatite (Ca5(PO4)3OH) with fluoroapatite (Ca5(PO4)3F). Fluoroapat it e is m ore resist ant t o acid at t ack and thus teeth which contain even a small proportion of fluoroapatite are less likely to decay. The relevant reactions are as follows:

Tooth decay: Ca 5(PO4)3OH(s) + 4H3O+ (aq) → 5 Ca 2+ (aq) + 3HPO4 2-(aq) + 5H2O(l) Fluoridation: Ca 5(PO4)3OH(s) + F-(aq) → Ca 5(PO4)3F(s) + OH-(aq)

Fluorid at ion of w at er in New Zealand is largely accep t ed (No it is not!), and there are only two major cities that do not adjust the fluoride level of their water supply. Referendum is becoming the norm for determining public opinion on whether to fluoridate or not. Three chemicals are in common use for this purpose, namely sodium fluoride, sodium fluosilicate and hydrofluorosilicic acid (HFA).

Submission No: 1064

Sodium fluoride Sodium fluoride is a white powder, moderately soluble in water (about 3% w/w). For water I-Ch e m i c al s-C-Hydrofluorosilicic acid-2 fluoridation p u r p o ses it is u su al t o p r ep are a sat urat ed solut ion in w at er and inject this solution into the bulk water. However, sodium fluoride is the most expensive of the three and for this reason is not widely used.

Sodium fluorosilicate Sodium fluorosilicate is a white powder sparingly soluble in water (about 0.6% w/w). This low solubility means that it is not feasible to use a saturated solution so dry solid is fed into bulk water at the appropriate rate. However, it can be difficult to control small flows of solid and this aspect of fluoridation equipment must be well designed and carefully monitored. Nevertheless, the fluorosilicate is widely used as it is significantly cheaper than the fluoride salt.

Hydrofluorosilicic acid Hydrofluorosilicic acid has several advantages. Being a liquid, it is easy to handle and to meter accurately into the bulk water. Plant operators do not have to manually handle fine powders. The acid is also the cheapest source of fluorine. However, it is corrosive and tends to fume, particularly at concentrations of above 20%. Its main drawback is that it is a comparatively dilute source of fluoride. 15% acid contains just under 12% fluorine by mass, whereas sodium fluoride contains 47% and sodium fluorosilicate 60%. Over long distance transport costs can make so lid chem icals m ore at t ract ive. All manufacturers of superphosphate produce hydrofluorosilicic acid as a b y-product.

THE HYDROFLUOROSILICIC ACID MANUFACTURING PROCESS

Step 1 - Production of SiF4 Superphosphate is manufactured by mixing together finely ground phosphate rock and sulfuric acid. A vigorous reaction occurs with considerable gas evolution. The gases given off are mainly steam and carbon dioxide, but there is also a small quantity of silicon tetrafluoride released (seeprevious article). Uncontrolled release of this gas to

Submission No: 1064

atmosphere could cause significant pollution so every fertiliser works has a gas scrub b er as an int egral p art of it s m anuf act ure p lant .

Step 2 - Hydrolysis of SiF4 Silicon tetrafluoride reacts readily with water, so it is removed from the other gases by a gas scrubber that is essentially a means of contacting the gas stream with finely divided droplets of water. The reaction with water hydrolyses the silicon tetrafluoride according to the equation: 3 Si F4 + 2H2O → 2H2Si F6 + Si O2 In this way 99% of the fluoride is removed from the gas stream, leaving only a very small quantity to be emitted. These emissions are covered b y a d ischarge p erm it and less t han 0.1 g s-1 fluoride is discharged to the atmosphere. The liquid from the scrubber is usually a dilute solution of hydrofluorosilicic acid, with a small amount of solid silica suspended in it. This dilute hydrofluorosilicic acid can be partially substituted for sulfuric acid in the production of superphosphate. In the New Plymouth works of Farmers Fertiliser Ltd the scrubbing p r o cess h as b een modified so as to produce an acid suitable for water fluoridation. In this w o r ks t h e scr u b b in g I-Ch e m i c al s-C-Hydrofluorosilicic acid-3 p r o cess is divided into three stages with acid of different concentration in each. This yields an acid containing about 20% H2SiF6 which is acceptable to local authorities. The superphosphate article has a flowsheet showing a typical scrubber installation for hydrofluorosilicic acid production. Water and gas are made to flow .countercurrent. to each other so that gas rich in fluoride is contacted by strong acid and gas weak in fluoride meets very dilute acid. Strong acid is pumped away from the first scrubber and settled to remove silica before being sold.

ENVIRONMENTAL AND FINANCIAL CONSIDERATIONS

This process removes fluoride from the gas stream, thus preventing an environmental hazard, but it does have its problems. The 20% acid is very corrosive to most metals, so scrubbing equipment is more costly than that used with plain water sprays. However, the demand in the North Island is sufficient to justify economic recovery.

Written by C.W. Harland (Farmers Fertiliser Ltd), revised by Lisa Donaldson (IChem Ltd) and Jenny Simpson (Farmers Fertiliser Ltd) with su m m ary box and editing by Heather Wansbrough.

Submission No: 1064

http://www.fannz.org.nz/pdfs/Sodium%20fluoride%2 0ORICA.pdf

Material Safety Data Sheet

1. IDENTIFICATION OF THE MATERIAL AND SUPPLIER Product Name: SODIUM FLUORIDE Recommended Use: Water fluoridation, steel degassing, wood and adhesive preservative, electroplating, glass manufacture, disinfectant. Supplier: Orica Australia Pty Ltd ABN: 99 004 117 828 Street Address: 1 Nicholson Street, Melbourne 3000, Australia Telephone Number: +61 3 9665 7111 Facsimile: +61 3 9665 7937 Emergency Telephone: 1 800 033 111 (ALL HOURS)

2. HAZARDS IDENTIFICATION This material is hazardous according to criteria of Safe Work Australia; HAZARDOUS SUBSTANCE. Classified as Dangerous Goods by the criteria of the Australian Dangerous Goods Code (ADG Code) for Transport byRoad and Rail; DANGEROUS GOODS. Risk Phrases: Toxic if swallowed. Contact with acids liberates very toxic gas. Irritating to eyes and skin. Safety Phrases: Do not breathe dust. Avoid contact with skin and eyes. In case of contact with eyes, rinse immediately with plenty of water and seek medical advice. Wear suitable protective clothing, gloves and eye/face protection. In case of accident or if you feel unwell, seek medical advice immediately (show the label whenever possible). Poisons Schedule: S6 Poison.

3. COMPOSITION/INFORMATION ON INGREDIENTS Components CAS Number Proportion Risk Phrases Sodium fluoride 7681-49-4 >=98% R25, R32, R36/38

4. FIRST AID MEASURES For advice, contact a Poisons Information Centre (e.g. phone Australia 131 126; New Zealand 0800 764 766) or a doctor at once. Urgent hospital treatment is likely to be needed. Inhalation: Remove victim from area of exposure - avoid becoming a casualty. Remove contaminated clothing and loosen remaining clothing. Allow patient to assume most comfortable position and keep warm. Keep at rest until fully recovered. Seek medical advice if effects persist. Skin Contact: If skin or hair contact occurs, immediately remove any contaminated clothing and wash skin and hair thoroughly with running water. If swelling, redness, blistering or irritation occurs seek medical assistance. Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: 000031020001 Version: 4

Material Safety Data Sheet

Submission No: 1064

Eye Contact: If in eyes, hold eyelids apart and flush the eye continuously with running water. Continue flushing until advised to stop by a Poisons Information Centre or a doctor, or for at least 15 minutes. Ingestion: Immediately rinse mouth with water. If swallowed, do NOT induce vomiting. Give a glass of water. Seek immediate medical assistance. Medical attention and special treatment: Treat symptomatically.

5. FIRE FIGHTING MEASURES Hazards from combustion products: Non-combustible material. Precautions for fire fighters and special protective equipment: Decomposes on heating emitting toxic fumes, including those of hydrogen fluoride , and sodium oxide . Fire fighters to wear self-contained breathing apparatus and suitable protective clothing if risk of exposure to products of decomposition. Suitable Extinguishing Media: Not combustible, however, if material is involved in a fire use: Fine water spray, normal foam, dry agent (carbon dioxide, dry chemical powder). Hazchem Code: 2Z

6. ACCIDENTAL RELEASE MEASURES Emergency procedures: If contamination of sewers or waterways has occurred advise local emergency services. Methods and materials for containment and clean up: Wear protective equipment to prevent skin and eye contact. Avoid breathing in dust. Work up wind or increase ventilation. Collect and seal in properly labelled containers or drums for disposal.

7. HANDLING AND STORAGE This material is a Scheduled Poison S6 and must be stored, maintained and used in accordance with the relevant regulations. Conditions for safe storage: Store in a cool, dry, well ventilated place and out of direct sunlight. Protect from moisture. Store away from foodstuffs. Store away from incompatible materials described in Section 10. Keep containers closed when not in use – check regularly for spills. Precautions for safe handling: Avoid skin and eye contact and breathing in dust. Avoid handling which leads to dust formation. Keep out of reach of children.

8. EXPOSURE CONTROLS/PERSONAL PROTECTION Occupational Exposure Limits: No value assigned for this specific material by the National Occupational Health and Safety Commission. However, Exposure Standard(s) for constituent(s): Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: 000031020001 Version: 4

Material Safety Data Sheet Fluorides (as F): 8hr TWA = 2.5 mg/m3 As published by the National Occupational Health and Safety Commission. TWA - The time-weighted average airborne concentration over an eight-hour working day, for a five- day working week over an entire working life. These Exposure Standards are guides to be used in the control of occupational health hazards. All atmospheric contamination should be kept to as low a level as is workable. These exposure standards should not be used as fine dividing lines between safe and dangerous concentrations of chemicals. They are not a measure of relative toxicity. Engineering controls:

Submission No: 1064

Ensure ventilation is adequate and that air concentrations of components are controlled below quoted Exposure Standards. Avoid generating and breathing in dusts. Use with local exhaust ventilation or while wearing dust mask. Keep containers closed when not in use.

Personal Protective Equipment: The selection of PPE is dependant on a detailed risk assessment. The risk assessment should consider the work situation, the physical form of the chemical, the handling methods, and environmental factors. Orica Personal Protection Guide No. 1, 1998: F - OVERALLS, SAFETY SHOES, CHEMICAL GOGGLES, GLOVES, DUST MASK. Wear overalls, chemical goggles and impervious gloves. Avoid generating and inhaling dusts. If dust exists, wear dust mask/respirator meeting the requirements of AS/NZS 1715 and AS/NZS 1716. Always wash hands before smoking, eating, drinking or using the toilet. Wash contaminated clothing and other protective equipment before storage or re-use.

9. PHYSICAL AND CHEMICAL PROPERTIES Physical state: Powder or Crystals Colour: White or Colourless Odour: Odourless Molecular Formula: NaF Specific Gravity: 2.78 @ 20°C Relative Vapour Density (air=1): 1.45 Vapour Pressure (20 °C): Not available Flash Point (°C): Not applicable Flammability Limits (%): Not applicable Autoignition Temperature (°C): Not applicable Solubility in water (g/L): 40 Melting Point/Range (°C): 988 Boiling Point/Range (°C): 1695 pH: 7.4 (freshly prepared saturated solution) Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: 000031020001 Version: 4

Material Safety Data Sheet 10. STABILITY AND REACTIVITY Chemical stability: Stable under normal conditions. Conditions to avoid: Avoid dust generation. Incompatible materials: Incompatible with acids. Hazardous decomposition products: Hydrogen fluoride. Sodium oxide. Hazardous reactions: Hazardous polymerisation will not occur.

11. TOXICOLOGICAL INFORMATION No adverse health effects expected if the product is handled in accordance with this Safety Data Sheet and the product label. Symptoms or effects that may arise if the product is mishandled and overexposure occurs are: Ingestion: Swallowing may result in nausea, vomiting, and abdominal pain. Swallowing large amounts may cause muscle spasms, coma and death from respiratory failure. Eye contact: An eye irritant. Skin contact: Contact with skin will result in irritation. Inhalation: Breathing in dust may result in respiratory irritation. Long Term Effects: Chronic fluorine poisoning is possible. Intake of more than 1.5 mg/L of fluoride can cause dental fluorosis with amounts of greater than 4 mg/L possibly causing skeletal fluorosis. Symptoms include weight loss, brittle bones, anaemia, weakness, and stiffness of joints.

Submission No: 1064

Toxicological Data: Oral LD50 (rat): 31 mg/kg. Oral LD50 (mice): 44 mg/kg. 12. ECOLOGICAL INFORMATION Ecotoxicity Avoid contaminating waterways.

13. DISPOSAL CONSIDERATIONS Disposal methods: Refer to Waste Management Authority. Dispose of material through a licensed waste contractor.

14. TRANSPORT INFORMATION Road and Rail Transport Classified as Dangerous Goods by the criteria of the Australian Dangerous Goods Code (ADG Code) for Transport by Road and Rail; DANGEROUS GOODS. Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: 000031020001 Version: 4

Material Safety Data Sheet 6 TOXIC UN No: 1690 Class-primary 6.1 Toxic Packing Group: III Proper Shipping Name: SODIUM FLUORIDE Hazchem Code: 2Z Marine Transport Classified as Dangerous Goods by the criteria of the International Maritime Dangerous Goods Code (IMDG Code) for transport by sea; DANGEROUS GOODS. This material is classified as a Marine Pollutant (P) according to the International Maritime Dangerous Goods Code. UN No: 1690 Class-primary: 6.1 Toxic Packing Group: III Proper Shipping Name: SODIUM FLUORIDE, SOLID Air Transport Classified as Dangerous Goods by the criteria of the International Air Transport Association (IATA) Dangerous Goods Regulations for transport by air; DANGEROUS GOODS. UN No: 1690 Class-primary: 6.1 Toxic Packing Group: III Proper Shipping Name: SODIUM FLUORIDE

15. REGULATORY INFORMATION Classification: This material is hazardous according to criteria of Safe Work Australia; HAZARDOUS SUBSTANCE. Hazard Category: T : Toxic Xi: Irritant Risk Phrase(s): R25: Toxic if swallowed. R32: Contact with acids liberates very toxic gas. R36/38: Irritating to eyes and skin. Safety Phrase(s): S22: Do not breathe dust. S24/25: Avoid contact with skin and eyes. S26: In case of contact with eyes, rinse immediately with plenty of water and seek medical advice. S36/37/39: Wear suitable protective clothing, gloves and eye/face protection.

Submission No: 1064

S45: In case of accident or if you feel unwell, seek medical advice immediately (show the label whenever possible). Poisons Schedule: S6 Poison. This material is listed on the Australian Inventory of Chemical Substances (AICS). Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: 000031020001 Version: 4

Material Safety Data Sheet

16. OTHER INFORMATION `Registry of Toxic Effects of Chemical Substances'. Ed. D. Sweet, US Dept. of Health & Human Services: Cincinatti, 2008. This material safety data sheet has been prepared by SH&E Shared Services, Orica. Reason(s) for Issue: Revised Primary MSDS Alignment to HSNO requirements This MSDS summarises to our best knowledge at the date of issue, the chemical health and safety hazards of the material and general guidance on how to safely handle the material in the workplace. Since Orica Limited cannot anticipate or control the conditions under which the product may be used, each user must, prior to usage, assess and control the risks arising from its use of the material. If clarification or further information is needed, the user should contact their Orica representative or Orica Limited. Orica Limited's responsibility for the material as sold is subject to the terms and conditions of sale, a copy of which is available upon request. Product Name: SODIUM FLUORIDE Issued: 17/10/2008

Substance No: 000031020001 Version: 4

Submission No: 1064

Studies on Tooth Decay Rates After Water Fluoridation Is Stopped

Fluoride Action Network | February 2001

ow nelement article.resize 2 31

For decades, the American Dental Association (ADA) has long warned that if communities end their water fluoridation programs, the rate of tooth decay will increase. In it’s “Fluoridation Facts” brochure, the ADA states:

“Dental decay can be expected to increase if water fluoridation in a community is discontinued for one year or more, even if topical products such as fluoride toothpaste and fluoride rinses are widely used.”

At the turn of the 21st century, however, a flurry of 4 published studies reported that tooth decay rates did not increase in communities that had ended fluoridation. In fact, in each of the studies, the rate of tooth decay continued to decrease.

The fact that tooth decay decreased following the end of fluoridation is consistent with the fact that tooth decay rates in all western nations have sharply declined over the past 50 years irrespective of whether the country fluoridates its water, or not.

Fluoridation Cessation Studies

1. Canada:

“The prevalence of caries decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community.” SOURCE: Maupome G, Clark DC, Levy SM, Berkowitz J. (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology 29: 37-47.

2. Finland

“The fact that no increase in caries was found in Kuopio despite discontinuation of water fluoridation and decrease in preventive procedures suggests that not all of these measures were necessary for each child.” SOURCE: Seppa L, Karkkainen S, Hausen H. (2000). Caries Trends 1992-1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation. Caries Research 34: 462-468.

3. Germany

Submission No: 1064

“In contrast to the anticipated increase in dental caries following the cessation of water fluoridation in the cities Chemnitz and Plauen, a significant fall in caries prevalence was observed.” SOURCE: Kunzel W, Fischer T, Lorenz R, Bruhmann S. (2000). Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Community Dentistry and Oral Epidemiology 28: 382-9.

4. Cuba

“In 1997, following the cessation of drinking water fluoridation, in contrast to an expected rise in caries prevalence, DMFT and DMFS values remained at a low level for the 6- to 9-year-olds and appeared to decrease for the 10/11-year-olds. In the 12/13-year-olds, there was a significant decrease, while the percentage of caries- free children of this age group had increased…” SOURCE: Kunzel W, Fischer T. (2000). Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Research 34: 20-5.

Submission No: 1064

Supplementary submission to the Inquiry into how to prevent child abuse and improve children's health outcomes Katherine Smith

Many NZ towns and cities add fluoride (often as hydrofluorosilicic acid) to town water supplies. This exposes the population to avoidable health risks. Risks pertaining to pregnant women, babies and young children include:

1) Increased risk of Down Syndrome The rate of children born with Down Syndrome is higher in in towns and cities where the water is fluoridated and in areas where the water is fluoridated mothers of children with Down Syndrome are likely to be younger than mothers of children with Down Syndrome living in non- fluoridated communities. Below is a summary of one paper on this issue: FLUORIDE-LINKED DOWN SYNDROME BIRTHS AND THEIR ESTIMATED OCCURRENCE DUE TO WATER FLUORIDATION Kosei Takahashi* Okegawa City, Saitama, Japan SUMMARY: Down syndrome (DS) birth rates (BR) as a function of maternal age exhibit a relatively flat linear regression line for younger mothers and a fairly steep one for older mothers with the second line intersecting the first line a little above maternal age 30. Consequently, overall DS-BR for all maternal ages are not a very reliable parameter for detecting environmental influences, since theymay be strongly affected by the ratio of the number of younger to older mothers. For this reason, data for mothers under age 30 were selected to detect an association between water fluoridation and DS for which the lower maternal age regression would be a much smaller contributing factor. The early research of I Rapaport indicating a link between fluoride in drinking water and Down syndrome was followed by studies claiming there was no such association. Application of sound methodology to the data in those later investigations shows that none of the criticisms against Rapaport's work are valid. For example, in the data of J D Erickson on maternal age-specific DS births in Metropolitan Atlanta, Georgia, when the three youngest maternal age subgroups are reasonably combined into single groups for areas with and without water fluoridation, a highly

Submission No: 1064 significant association (P < 0.005) is revealed between fluoridated water and DS births. It also appears that the dose-response line (DRL) of DS-BR for daily fluoride intake may have no allowable level that does not induce fluoride- linked DS births. Therefore fluoride may be one of the major causes of DS other than aging of mothers. The number of excess DS births due to water fluoridation is estimated to be several thousand cases annually throughout the world. Key Words: Down syndrome; Down syndrome births; Fluoridation; Fluoride intake. *Department of Internal Medicine and Biostatistics, Tokyo University Medical School, Tokyo, Japan (retired). Home address: Kosei Takahashi MD PhD, Kano 1788, Okegawa City, Saitama, 363-0001 Japan. The full text article is at this link: http://fluoride-journal.com/98-31-2/31261- 73.htm A more general summary of some of the research on fluoride and Down Syndrome may be read at this link. http://www.fluoridealert.org/downs-syndrome.htm It should be noted that the government has recently introduced prenatal screening in the first trimester of pregnancy to try to identify babies who have this condition very early in their development. This screening was introduced without adequate consultation with the community of families with Down Syndrome children. It has caused considerable alarm and offence as it has been interpreted (and correctly in my view) to be a eugenics project that has the aim of selectively targeting people with Down Syndrome for elimination due to their perceived disabilities. Overseas where this type of screening has been introduced, 90% of babies with Down Syndrome have been aborted. There have been disturbing reports that some NZ parents have been pressured to abort on the basis of these tests showing that a baby may have Down Syndrome. (See: http://www.stuff.co.nz/national/health/6952705/Reaction-stuns-Down- Syndrome-mother ) Research into the after effects of abortion has shown that termination of a wanted pregnancy has a higher likelihood of causing adverse Page 2 of 7 24/05/2012 outcomes for the mother, such as depression. If the government really wants to to reduce the numbers of children who are born with Down Syndrome, ending water fluoridation and putting warning labels on products that contain high levels of fluoride such as fluoride toothpastes, chewing gums etc would seem to be a much more humane and life affirming approach than promoting pre-natal testing and abortions.

Submission No: 1064

2) Increased risk of anaemia in pregnancy Research in India (where water from some wells is naturally high in fluoride, and some people use "black salt" and drink black tea which has a high fluoride content) has found that reducing fluoride consumption and nutritional counselling helps resolve anaemia in pregnant mothers. The proportion of mothers who received this intervention whose babies were born premature or with a low birth weight was also substantially reduced. (The reduction in fluoride intake would be expected to help reduce anaemia even without the additional nutritional counseling as fluoride has toxic effects on the microvilli of the intestinal tract, reducing nutrient absorbtion; reducing fluoride intake allows these microvilli to nregenerate.) Below is an excerpt from the abstract: "Anaemia in pregnancy and low birth weight babies, a serious public health problem, troubles India and several other nations. This article reports the results of a approach to address the issue. Women up to 20 week pregnancy with haemoglobin (Hb) 9.0 g/dl or less, those with urinary fluoride beyond 1.0 mg/l and not suffering from any other ailments, were selected. Out of the 205 pregnant women attending antenatal clinics (ANCs) during 1st and 2nd trimesters, the sample and control groups were selected through computerized random sampling procedure. "Ninety pregnant women formed the sample group and 115 formed the control group. The sample group was introduced to two interventions, viz.: (1) removal of fluoride from ingestion through drinking water, food and other sources, (2) counselling based intake of essential nutrients, viz. calcium, iron, folic acid, vitamins C, E and other antioxidants through dairy products, vegetables and fruits. No intervention was introduced for the control group. Sample and control groups were monitored for urinary fluoride and Hb until delivery during their visits to ANC. Birth weight of the babies were recorded from the labour room register. Results reveal that (1) the urine fluoride levels decreased in 67% and Page 3 of 7 24/05/2012 53% of the pregnant women respectively, who attended ANCs during 1st and 2nd trimester of pregnancy. (3) An increase in Hb upon withdrawal of fluoride followed by nutritional intervention in 73% and 83% respectively has also been recorded. (3) Body mass index (BMI) also enhanced. (4) The percentage of pre-term deliveries was decreased in sample group compared to control. (5) Birth weight of babies enhanced in 80% and 77% in sample group women who attended ANC in 1st and 2nd trimester respectively as opposed to 49% and 47% respectively in the control group. (6) The number of low birth weight babies was reduced to

Submission No: 1064

20% and 23% respectively in sample as opposed to 51% and 53% in control groups. “Effective interventional approach to control anaemia in pregnant women” A. K. Susheela1, N. K. Mondal1, Rashmi Gupta1, Kamla Ganesh1, Shashikant Brahmankar1, Shammi Bhasin2 and G. Gupta2 CURRENT SCIENCE, VOL. 98, NO. 10, 25 MAY 2010; 1320 - 1330 1Fluorosis Research and Rural Development Foundation, 34, I.P. Extension, Delhi 110 092, India 2Department of OBGY, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi 110 064, India More information on this issue, may be read at this link: http://www.fluorideandfluorosis.com/Activities/Anaemia.html

3) Increased risk of premature labour A recent (2009) American study found increased risks of premature labour and birth for pregnant women living in areas where the water is fluoridated. This risk remained even after taking into account other variables such as poverty – although the study also showed that poor women and their babies are more vulnerable to the toxic effects of fluoride than wealthier women. Below is an excerpt from the study's abstract: "The annual incidence of preterm birth (PTB) (<37 weeks gestation) in the United States is approximately 10% and is associated with considerable morbidity and mortality. Current literature suggests an association between periodontal disease and PTB. Domestic water fluoridation is thought to have lessened the burden of dental disease. Theoretically, one would expect water fluoridation to be protective against PTB. The aim of our study was to examine Page 4 of 7 24/05/2012 the relationship between municipal water fluoridation and PTB. A retrospective, cohort study was conducted using the Statewide Planning and Research Cooperative System(SPARCS) database. Inclusion criteria were 1) women with live singleton births between 1993 and 2002 (ICD-9- CM); 2) residence in Upstate New York State; 3) residence in a zip code fully contained within a county; and 4) residence in a county where municipal water fluoride content was uniformly therapeutic (≥1.0 mg/L) or sub-therapeutic(<1.0 mg/L). "Domestic water fluoridation was associated with an increased risk of PTB (9545 (6.34%) PTB among women exposed to domestic water fluoridation versus 25278 (5.52%) PTB among those unexposed, p < 0.0001)). This relationship was most pronounced among women in the lowest SES groups (>10% poverty) and those of non-white racial origin. Domestic water fluoridation was independently associated with an increased risk of PTB in

Submission No: 1064 logistic regression, after controlling for age, race/ethnicity, neighborhood poverty level, hypertension, and diabetes." https://apha.confex.com/apha/137am/webprogram/Paper197468.html

4) Increased infant mortality The government in Chile ceased water fluoridation after an increase in infant mortality was experienced in fluoridated areas. Dr Albert Schatz (discoverer of the antibiotic streptomycin used in the treatment of tuberculosis) found that water fluoridation was associated with increased congenital malformations and increased infant mortality. A table of data from Chilean Government records is presented below. Curico was fluoridated at one part per million. There was 0.0% fluoride in the water at San Fernando. Original source: Schatz A. Increased Death Rates in Chile with Artificial Fluoridation ofDrinking Water, with Implications for other Countries. Journal of Arts Humanities and Science :1-17. Cause of Death 1953-63 City Deaths Congenital malformations Curico (fluoride) 3.1 % Extra deaths = 244% San Fernando 0.9 % Digestive system Curico (fluoride) 18 per 10,000 Extra deaths = 50% San Fernando 12 per 10,000 Total infant mortality Curico (fluoride) 56.5 per 10,000 Extra deaths = 69% San Fernando 33.4 per 10,000 All causes, all age groups Curico (fluoride) 2255 Extra deaths = 16% San Fernando 1003 Page 5 of 7 24/05/2012 In the USA American PhD biochemist, Dr John Yiamouyiannis compared 10 fluoridated USA cities with 10 non-fluoridated ones. Between 1950 and 1969, the infant mortality rate per 1000 live births for nonwhites in the non-fluoridated cities fell by 9.03/thousand. In the fluoridated cities the drop was only 1.93/thousand = 4.7 times better in non-fluoridated cities For white Americans – regarded in the States as better nourished than nonwhites – the non-fluoridated city rate fell by 5.22/thousand while the fluoridated decrease was only 3.33/thousand

Submission No: 1064

= 1.7 times better in non-fluoridated cities Note: total rates: Risk of PTB 6.34% in women exposed to water fluoridation Risk of PTB 5.52% in women NOT exposed to water fluoridation Difference 15%

5) Neurotoxic effects of fluoride may reduce children's intelligence A major review of neurotoxic agents that have potential to cause developmental neurotoxicity noted that fluoride has been shown to have neurotoxic effects in animals and that children with high fluoride intakes (through drinking well water that contains high levels of the fluoride) have lower IQs. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2806% 2969665-7/fulltext Please note that the even though the American Dental Association supports the use of fluoridated products (including water) it recognises that using fluoridated water to make up powdered infant formula may increase the risk of dental flourosis in babies. (Dental fluorosis is the name given to tooth enamels that has been discoloured and damaged due to accumulation of toxic levels of fluoride.) http://jada.ada.org/content/142/1/79.full Human breast milk contains negligible fluoride (0.005 - 0.01 ppm fluoride) whereas the fluoride content of fluoridated water is around 1 ppm. Formula fed babies whose powdered breast milk substitutes are made up with fluoridated tap water are therefore receiving at least 100 times more fluoride than their breast-fed peers. Given the neurotoxicity of fluoride this may help to account for the fact that breast fed babies are more intelligent than those fed on formula – although there are many other possible explanations.

Recommendations: In order to reduce the risk of birth defects, premature births, excess infant mortality and neurotoxic effects associated with fluoride consumption, the government should do the following: 1) End water fluoridation immediately 2) Put warning labels of fluoridated toothpaste, chewing gums etc so that people realise that the fluoride these contain poses a health risk 3) Produce a pamphlet for parents (including prospective parents in the preconceptual period) about the risks of products containing fluoride to the health of their developing baby (in utero and subsequently) such as fluoride containing toothpaste, gums etc as well as foods that contain high levels of fluoride such as black tea

Submission No: 1064

Another Submission by Kathryn Smith

http://www.parliament.nz/NR/rdonlyres/9156BA1D-A75D-4CB5-B175- 940155FB5FB4/226151/50SCHE_EVI_00DBSCH_INQ_11221_1_A241560_Katheri neSm.pdf

Submission No: 1064

FLUOROSIS

When fluoride was first added to water in the 1940s as a means of preventing tooth decay, not a single dental product contained fluoride: no fluoride toothpastes, no fluoride mouth-rinses, no fluoride varnishes, and no fluoride gels. In the past 60 years, as one fluoride product after another entered the market, exposure to fluoride increased considerably, particularly among children.

Exposure from other sources has increased as well. Other sources include processed foods made with fluoridated water, fluoride-containing pesticides, bottled teas, fluorinated pharmaceuticals, teflon pans, and mechanically deboned chicken. Taken together, the glut of fluoride sources in the modern diet has created a toxic cocktail, one that has caused a dramatic increase in dental fluorosis (a tooth defect caused by excess fluoride intake) over the past 60 years. The problem with fluoride, therefore, is not that children are receiving too little, but that they are receiving too much.

Even advocates of fluoridation have begun to recognize this problem. In January 2011, the U.S. Department of Health and Human Services (DHHS) announced its recommendation that water fluoridation programs (which generally add 1 ppm

Submission No: 1064

fluoride to water) should lower the levels added to 0.7 ppm. This reduction, however, does little to solve the problem, as many children will continue to ingest more fluoride than is recommended, or safe.

Submission No: 1064

Dental Fluorosis Incidence in New

Zealand

Dental fluorosis is a defect in tooth enamel caused by fluoride poisoning of the body cells that make the tooth enamel. It appears as discolouration of the tooth, from white flecks to brown or black staining in advanced cases. It is the first sign of fluoride poisoning of children while their teeth are forming. The US National Research Council's 2006 report identified a number of studies linking dental fluorosis with other more serious adverse health effects.

Two studies have been conducted in NZ since 2000 - the Southland study 2005 (below) and the Auckland study 2008.

The Auckland Study 2008

Prevalence of enamel defects and dental caries among 9-year-old Auckland children. Schulter PJ, Kanagaratnam S, Durward CS, Mahood R NZ Dental Journal December 2008 (p145-152)

Summary

This study found that water fluoridation increases the incidence of dental fluorosis, but has no lasting benefit in reducing tooth decay.

The study concluded that there had not been a significant increase in fluorosis incidence since the 1980s (which was already 3 times higher than predicted when fluoridation was first proposed). The levels reported then were around 25% to 28% (Colquhoun, 1985).

Dental fluorosis incidence

• 29.1% of fluoridated children had dental fluorosis compared with 14.7% of unfluoridated children • Diffuse opacities (dental fluorosis) were the predominant tooth defects

Tooth decay rates

Submission No: 1064

• There was no difference in tooth decay rates in the permanent teeth (this differs from the Southland study, but at age 9 there is often an apparent benefit, likely due to delayed tooth eruption caused by fluoridation, that disappears by age 12 to 15 – see Armfield and Spencer, 2004) • There was no statistically significant difference in tooth decay rates in deciduous (“baby”) teeth based on affected tooth surfaces (dmfs score) • Fluoridated children had less tooth decay in deciduous teeth on a per tooth basis (dmft) and number of children caries free (62% v 55%)

The study noted that:

• international research shows that the increase in dental fluorosis levels is directly related to total fluoride intake, and detectable even at small differences in intake • the swallowing of fluoride toothpaste by very young children (perhaps 50% of that placed on the toothbrush) is a risk factor (note – the Ministry of Health, NZ Dental Association, and Plunket advocate practices that significantly increase the amount of fluoride swallowed by young children) • the effect of fluoride in (allegedly) reducing tooth decay is primarily due to topical effect after the tooth has erupted (i.e. not from swallowing it). • fluoride tablets taken before tooth eruption have little effect on tooth decay but “present a clear risk for fluorosis”.

Method

This study examined 310 fluoridated and 302 unfluoridated children, based on current fluoridation status.

About half the children had intermittent residence in fluoridated areas, and some were unknown. It is not stated when the exposure occurred, even though international studies show that it is the time of exposure that is critical in causing fluorosis – the first 6 months is most critical if bottle fed, with reducing but significant risk up to age 4. The 2005 Southland study also showed a higher incidence of fluorosis in those who had lived in fluoridated areas up to age 4.

The study did not separate out those who had had lifelong exposure to fluoridation, though it utilised a complex statistical modelling to counteract, in part, this shortfall. We do not consider the other “justifications” tenable if the purpose was to determine the effects of water fluoridation.

Submission No: 1064

Socio economic status was determined by the school decile rating, rather than the SES status of each child. Although this approach is not considered appropriate, the results suggest it has not significantly impaired the study. There was a significant difference in SES status between fluoridated and unfluoridated children (the unfluoridated children has the lower SES status, which international studies show is the main factor in higher levels of tooth decay). Many of the first molar permanent teeth, at higher risk of decay than other teeth, were fissure- sealed. This would corrupt the caries results, but, if so, seems to demonstrate that fissure-sealing is a more effective method of caries prevention than fluoridated water.

The Southland Study 2005

Enamel defects and dental caries among Southland children Mackay T D, Thomson W M, NZ Dental Journal 101, No. 2, June 2005 (p35-43)

Key findings from this study were as follows.

Dental fluorosis incidence

• There were no socioeconomic differences in relation to dental fluorosis • The prevalence of diffuse opacities (and therefore the overall prevalence of any defect) was higher amongst those who continuously resided in fluoridated areas up to the age of 4. (Note: This should be read in conjunction with the 2008 Auckland study, which did not consider the age of exposure)

Tooth decay rates

• Socioeconomic status (SES) did not affect tooth decay rates (note: international studies show that SES is the main determinant of dental health/ tooth decay. See in particular Armfield and Spencer 2004) • There was no benefit from fluoridation to the deciduous (“baby”) teeth • There was no benefit to permanent teeth in the initial results. Following furtehr data manipulation, it was claimed that those 9 year olds who lived all their lives in fluoridated areas had half the decay (equating to ½ a filling) than those who had never lived in a fluoridated area. This finding conflicts with the 2008 Auckland study, which found no such benefit. However, at age 9 there are few permanent teeth, and they have had only brief exposure to decay, as noted in the Auckland study. 12 years old is the WHO-prescribed

Submission No: 1064

age for examining permanent teeth effects. International studies show there is often an apparent benefit at younger ages, likely due to delayed tooth eruption caused by fluoridation, but which disappears by age 12 to 15 – see Armfield and Spencer (2004); Newbrun (1989).

Implications of increased dental fluorosis

The study notes that “the clinical… and public health significance of [diffuse opacities (i.e. dental fluorosis) remains unclear”. In other words, we do not know what associated health risks there may be! The US National Research Council Review, published in 2006, found a number of studies linking dental fluorosis to other adverse health effects.

Method

436 children between the ages of 9 and 10 were examined. 137 children had not lived in fluoridated communities (but may have been given fluoride tablets – the analysis does not control for this; 116 had intermittent residence in fluoridated communities; and 183 had always lived in fluoridated communities.

Socioeconomic status was determined by the school decile rating, rather than the SES status of each child. This approach is not considered appropriate. It is not clear from the results whether this has had a significant impact.

Although a range of intersecting population characteristics was recorded, individual analysis tables look at only one factor at a time. These results are therefore meaningless, as a correlation between high decile and fluoridation status, for example, precludes any conclusion as to which factor was relevant. The fact that high decile children had the highest rates of dental fluorosis suggests there was such a correlation. The use of fluoride tablet would be exclusively among non-fluoridated children (including, possibly, intermittently fluoridated). Without controlling for this in each set of results, an “unfluoridated” child becomes a “fluoridated” child for analytical purposes.

The authors conducted a multivariate analysis for permanent tooth decay only. This approach is intended to find a common factor giving rise to results. There are many ways of conducting such an analaysis. It is not possible to determine whether the particular approach used was appropriate or not without the raw data. On the face of it, it appears that the data may have been manipulated to show a desired result when that result was not shown by standard analysis. As the saying goes "you can 'prove' anything with statistics."

Submission No: 1064

Overall, we feel compelled to recommend that their conclusions be viewed with extreme caution without an independent statistical analysis being available. Fluoride Is Not an Essential Nutrient

Fluoride Action Network | August 2012 | By Michael Connett

In the 1950s, dentists believed that fluoride was a “nutrient.” A nutrient is a vitamin or mineral that is necessary for good health. Dentists believed that fluoride ingestion during childhood was necessary for strong, healthy teeth. A “fluoride deficiency” was thus believed to cause cavities, just like a deficiency of calcium can cause osteoporosis, or a deficiency of vitamin-D can cause rickets. It is now known, however, that fluoride is not a nutrient. As acknowledged by the CDC, the fluoride content of a tooth has little bearing on whether or not the tooth will develop a cavity. According to the CDC:

“The prevalence of dental caries in a population is not inversely related to the concentration of fluoride in enamel, and a higher concentration of enamel fluoride is not necessarily more efficacious in preventing dental caries.” SOURCE: CDC (2001). Recommendations for using fluoride to prevent and control dental caries in the United States. Mortality and Morbidity Weekly Review 50(RR14):1-42.

In short, people can have perfect teeth without consuming fluoridated water or any other fluoride product. As with teeth, no other tissue or cellular process requires fluoride. Accordingly, it is now accepted that fluoride is not an essential nutrient.

Excerpts from the Scientific Literature:

“Safe, responsible, and sustainable use of fluorides is dependent on decision makers (whether they be politicians or parents) having a firm grasp on three key principles: (i) fluorine is not so much ‘essential’ as it is ‘everywhere,’ (ii) recent human activities have significantly increased fluorine exposures to the biosphere, and (iii) fluorine has biogeochemical effects beyond bones and teeth.” SOURCE: Finkelman RB, et al. (2011). Medical geology issues in North America. in O. Selinus, et al. (eds). Medical Geology. Springer Publishing.

“Fluoride is not essential for human growth and development.” SOURCE: European Commission. (2011). Critical review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water. Scientific Committee on Health and Environmental Risks (SCHER).

“Fluoride is not in any natural human metabolic pathway.” SOURCE: Cheng KK, et al. (2007). Adding fluoride to water supplies. British Medical Journal 335:699-702.

Submission No: 1064

“[F]luoride is no longer considered an essential factor for human growth and development.” SOURCE: National Research Council (1993). Health Effects of Ingested Fluoride. National Academy Press, Washington DC. p. 30.

“These contradictory results do not justify a classification of fluorine as an essential element, according to accepted standards.” SOURCE: National Academy of Sciences. (1989). Recommended Dietary Allowances: 10th Edition. Commission on Life Sciences, National Research Council, National Academy Press. p. 235.

Statements from U.S. Government Agencies:

“In summary, FDA does not list fluorine as an essential nutrient.” SOURCE: Food & Drug Administration, October 1990.

“The United States Public Health Service does not say that sodium fluoride is an essential mineral nutrient.” SOURCE: U.S. Public Health Service, May 10, 1966.

“Sodium fluoride used for therapeutic effect would be a drug, not a mineral nutrient. Fluoride has not been determined essential to human health. A minimum daily requirement for sodium fluoride has not been established.” SOURCE: Food & Drug Administration, August 15, 1963.

The Institute of Medicine Report (1997)

Some commentators have cited a 1997 report from the Institute of Medicine (IOM) as demonstrating that fluoride is an essential nutrient. The IOM report, however, does not do so — a fact confirmed by both the President of the Institute of Medicine (Kenneth Shine), as well as the President of the National Academy of Sciences (Bruce Alberts). In a jointly authored letter on November 18, 1998, Alberts and Shine unequivocally stated:

“Nowhere in the report is it stated that fluoride is an essential nutrient. If any speaker or panel member at the September 23rd workshop referred to fluoride as such, they misspoke. As was stated in Recommended Dietary Allowances 10th Edition, which we published in 1989: ‘These contradictory results do not justify a classification of fluoride as an essential element, according to accepted standards.’”

Submission No: 1064

Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries

F.A.N. | July 2012 | By Michael Connett

Fluoride advocates often claim that the reduction in tooth decay that has occurred since the 1950s is the result of the widespread introduction of fluoridated water. In 1999, for example, the Centers for Disease Control stated that ”as a result [of water fluoridation], dental caries declined precipitously during the second half of the 20th century.” As support for this assertion, the CDC published the following figure:

SOURCE: Centers for Disease Control (1999). Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries. MMWR 48:933-40.

What the CDC failed to mention is that tooth decay rates have “precipitously declined” in all western countries, irrespective of whether the country ever fluoridated its water. Indeed, most western countries do not fluoridate their water and yet their tooth decay rates have declined at the same rate as the U.S. and other fluoridated countries. This fact, which is widely acknowledged in the dental literature (see below), can be quickly demonstrated by examining the World Health Organization’s (WHO) data on tooth decay trends in each country. The following two figures and table, for example, compare the tooth decay trends in western countries with, and without, water (or salt) fluoridation.

Submission No: 1064

DMFT (Decayed, Missing & Filled teeth) Status for 12 year olds by Country - World Health Organization Data (2012) -

Country DMFTs Year Status*

Denmark 0.7 2008 No water fluoridation. No salt fluoridation.

Germany 0.7 2005 No water fluoridation. 67% salt fluoridation.

England 0.7 2009 11% water fluoridation. No salt fluoridation.

Netherlands* 0.8 2002 No water fluoridation. No salt fluoridation.

Switzerland** 0.82 2009 No water fluoridation. 88% salt fluoridation.

Belgium 0.9 2009-10 No water fluoridation. No salt fluoridation.

Sweden 0.9 2008 No water fluoridation. No salt fluoridation.

Australia 1.0 2003-2004 80% water fluoridation. No salt fluoridation.

Austria 1.0 2002 No water fluoridation.

6% salt fluoridation.

Ireland 1.1 2002 100% water fluoridation in study. No salt fluoridation.

Italy 1.1 2004 No water fluoridation. No salt fluoridation.

United States 1.19 1999-2004 64% water fluoridation. No salt fluoridation.

Finland 1.2 2006 No water fluoridation. No salt fluoridation.

Submission No: 1064

France 1.2 2006 No water fluoridation. 65% salt fluoridation.

Spain 1.3 2004 11% water fluoridation. 10% salt fluoridation.

Greece 1.35 2005-06 No water fluoridation. No salt fluoridation.

Iceland 1.4 2005 No water fluoridation. No salt fluoridation.

New Zealand 1.4 2009 61% water fluoridation. No salt fluoridation.

Japan 1.7 2005 No water fluoridation. No salt fluoridation.

Norway 1.7 2004 No water fluoridation. No salt fluoridation.

* The Hague | ** Zurich

Tooth Decay data from:

• World Health Organization Collaborating Centre for Education, Training, and Research in Oral Health, Malmö University, Sweden. http://www.mah.se/CAPP/

Salt fluoridation data from:

• Gotzfried F. (2006). Legal aspects of fluoride in salt, particularly within the EU. Schweiz Monatsschr Zahnmed 116:371-75.

Submission No: 1064

World Health Organisation Figures statistics on dental health of 12 year olds

"Fluoridation is the greatest fraud that has ever been perpetrated, and it has been perpetrated on more people than any other." - Dr. Albert Schatz, biochemist and co-discoverer of streptomycin

Improvement is the same in fluoridated and non-fluoridated countries

Country Year DMFT Year DMFT Fluoridation status

Ireland 1972 5.4 1992 1.9 66%

Finland 1975 7.5 1991 1.2 Nil

Denmark 1978 6.4 1992 1.3 Nil

UK (GB&NI) 1973 4.7 1993 1.4 10%

Sweden 1977 6.3 1994 1.5 Nil

Holland 1974 6.5-8.2 1991 1.7 Nil

Switzerland 1963-1975 2.3-2.9 1987-1989 2 Nil

France 1975 3.5 1993 2.1 Nil

Norway 1973 8.4 1991 2.3 Nil

Spain 1968-1969 1.9 1993 2.3 one city only

Germany (E) 1973 6 1994 2.5 Nil

Germany (W) 2.6 Nil

Belgium 1972 3.1 1991 2.7 Nil

Austria 1973 1.0-3.5 1993 3 Nil

Submission No: 1064

Italy 1978-1979 4.0-6.9 1985 3 Nil

Portugal 1979 4.6 1989 3.2 Nil

These figures are charted below, with New Zealand's figures added for comparison. Note that Ireland has around 70% fluoridation

Submission No: 1064

The Hastings Fluoridation Experiment

Five decades ago, two neighbouring towns, Hastings and Napier, were selected for the first fluoridation experiment in New Zealand: fluoridation was implemented in Hastings, with non- fluoridated Napier acting as the control. This arrangement has not changed. Data shows that even after 50 years, fluoridation has conferred no benefit to Hastings inhabitants, regardless of social status.

Figures based on data obtained under the Official Information Act:

Submission No: 1064

In fact, the NZ Government knew fluoridation was having no benefit, but had seemingly committed to fluoridation policy before the experiment began, as this letter shows:

Submission No: 1064

The Hastings Fluoridation Experiment:

Science or Swindle?

By John Colquhoun and Robert Mann (http://exacteditions.theecologist.org/exact/browse/307/308/5395/3/21)

Those in favour of fluoridation have hailed the Hastings Fluoridation Scheme in New Zealand as valuable evidence of the benefits on children's teeth of fluoride. However, studies of the scheme such as by the authors show it to be seriously flawed from a scientific point of view. In fact, the data reveal no positive advantage to children's health as a result of being exposed to fluoride in water.

The controversy over fluoridation or public water supplies is normally seen as a weighing of costs against benefit. The costs, apart from financial inputs, are claimed to be various illnesses what have proved difficult to quantify or even to attribute to fluoridation. The benefit is taken to be causation of major decreases in tooth decay. One of the surveys usually cited as showing this benefit has now been found to show no such thing.

The Hastings fluoridation study in New Zealand, 1954-1970 (New Zealand Dental Journal, vols. 54, 55, 58, 59, 61, 67), is listed in textbooks throughout the world as an important study confirming the effectiveness of water fluoridation (e.g. J.J. Murray, Fluoride in Caries Prevention. Wright, Bristol, 1982). Data from the study were used by Backer Dirks, the distinguished European researcher and advocate of fluoridation, in one of his better known and oft-cited published papers (Caries Research, vol. 8, suppl. p2.). Professor Murray's book, after reviewing the famous United States trials, saying of the Backer Dirks and Hastings studies they reinforced the European finding because ''free smooth-surface caries was reduced by 87 per cent ... approximal caries by 73 per cent ... and occlusal surface caries by 39 per cent " The greatest reductions were among 6-year-olds - 74 per cent by 1961 and 87 per cent by 1964 -

Submission No: 1064

but the greatest part of these had occurred in the first few years of the project: 42 per cent by 1957 and 61 per cent by 1959. These spectacular reductions, following a Commission of Inquiry report in favour of fluoridation (Government Printer, Wellington, 1957), led to acceptance of widespread fluoridation in New Zealand.

Hastings was chosen for such an experiment because its Council had already decided to fluoridate its water supply, the first to do so in New Zealand following an approach from the local branch of the Dental Association. It was considered to be a 'typical' New Zealand population, and therefore ideally suitable. At first described as an 'experiment' with a neighbouring town Napier, using essentially the same groundwater unfluoridated (0.15 ppm), as ''an ideal control" (Cabinet decision, March 1952, National Archives), the project was later changed to a before-and-after 'demonstration' (NZ Dental J., vol. 59, p.219). Editor's note: If anyone has any doubts about American influence, it should be noted that Dr. Frank Bull, fluoridation promoter extraordinaire, said at the infamous 1952 conference of US State Dental Directors: "We never conduct "experiments." We have told the public fluoridation is proven effective. We conduct "demonstrations""

The study's initial dental surveys of children in the two towns were not carried out until late 1954, almost two years after Hastings was first fluoridated. The follow-up survey in 1957 was reported to show a dramatic reduction in dental decay in Hastings after only 27 months of 'continuous fluoridation'. However, both the first and follow-up surveys had shown that the younger (under 10-year-old) control children had significantly less decay than the children of the same age in Hastings. It was said that a special protective factor - the trace element molybdenum in recent marine soil - had caused Napier decay rates to be below the average for the country. Because of that difference, the decision was made to discontinue the use of Napier as a control. Child dental decay rates being very high in New Zealand, it was reasoned that further continuous and marked reduction in dental decay among Hastings children would establish the effectiveness of fluoridation.

The Hastings study was carried out by Mr (later Dr) T.G. Ludwig, who replaced Dr R.E.T. Hewat as Dental Research Officer of the New Zealand Medical Research

Submission No: 1064

Council. Both have since died. Ludwig worked under the direction of the Fluoridation Committee of the Department of Health in Wellington. Most members of that Committee were officers of that Department. Co-opted on to it was a representative of the New Zealand Dental Association, Colonel (now Brigadier) J. Ferris Fuller. The latter became its chairman, and soon assumed a major role in direction of the Hastings operation. Ludwig's work also required the approval of the Dental Research Committee of the Medical Research Council, centred in Dunedin with the University of Otago's Dental Faculty, which followed the project closely. Colonel Fuller later became chairman of that Committee as well.

The New Zealand Official Information Act 1982 has made available for public perusal the archives of government departments. Department of Health Head Office files (nos. 125/299, 125/299/1, 2 & 3 and 124/30/31 & 33) now held in National Archives, Wellington, and other official and professional sources, reveal a considerable amount of information not in agreement with the currently accepted published version of the Hastings fluoridation study:

1) The claimed reductions in decay, which were greatest for the younger children, were brought about partly, if not mainly, by a local change in diagnostic procedure following the introduction or fluoridation

2) Reductions over such short periods are, by today's statistical standards, beyond the ''limit of credibility'' for genuine decay reductions.

3) A reduction in dental decay occurred in other, non-fluoridated, places throughout New Zealand during the time of the studv, making it difficult for public health officials to present convincing statistics showing that the claimed reductions were related to fluoridation. The reduction occurred in the control town as elsewhere.

Change in diagnostic Procedure

Most of the younger children involved in the experiment received their dental treatment regularly at school dental clinics, staffed by the then unique New Zealand grade of dentist called ''school dental nurse". In a 1957 report to the Fluoridation

Submission No: 1064

Committee, entitled ''Investigation of diagnostic standards of dental nurses in Hastings and Napier", Ludwig expressed concern that "the meticulous diagnostic standards of the dental nurses in Hastings might overshadow any improvement in the caries prevalence resulting from fluoridation". During the latter part of 1955, he wrote, he met each nurse and explained to her the diagnostic standards required by the study and illustrated these standards by examining a number of children in company with her. "While this procedure enabled one or two nurses to cooperate effectively by taking a more lenient view of possible very early carious lesions it did not seem to be successful generally "

The report continued: "To determine the actual extent of the problem the following course was adopted. Each dental nurse operating in Hastings and Napier was asked to examine twenty children, recording her findings and then to leave these children untreated until further notice. The nurses were not informed of the purpose of the examinations. The dental research officer and the Principal Dental Officer for Hawke's Bay then visited the Hastings and Napier clinics and examined suitable children previously examined by the nurses. The results of the three examiners were then compared and those for Hastings are given in Table 1. The results for Napier are given in Table 2 and include the results of the nurses and of the dental research officer only. The findings tabulated apply only to carious lesions upon the occlusal surfaces of molars.

Tables 1 and 2. Reproduced exactly from T.G. Ludwig's report to Fluoridation Committee: "Investigation of diagnostic standards of dental nurses in Hastings and Napier." The "diagnostic standards required" after the experiment's initial dental examinations called for a reduction in the number of cavities requiring filling to almost a quarter of the number found by the dental nurses using their earlier standards.

TABLE 1

Comparison of Diagnostic Standards of Hastings Dental Nurses, T.G. Ludwig and Principal Dental Officer (Gisborne)

Submission No: 1064

Hastings Nurses T.G.L. P.D.O.

No. of Patients Examined 51 51 51

No. Lesions Diagnosed as Carious 77 20 22

Average Number of Lesions per Child 1.51 0.39 0.43

TABLE 2

Comparison of Diagnostic Standards of Napier Dental Nurses and Dental Research Officer

Napier Dental Nurses * D.R.O.

No. of Patients Examined 32 32

No. of Teeth Diagnosed as Carious 75 23

Average No. Teeth Carious per Child 2.34 0.72

* Note: Given as T.G.L. in original article.

Source: Department of Health file: Hastings Study, 1956-70, National Archives, Wellington.

These tables summarised the results of the dental research officer for 7 Hastings and 4 Napier school dental nurses. They show that on average the dental nurses, even after two years of persuasion to alter their earlier standards which were still maintained in the rest of New Zealand, were still finding almost four times as many cavities requiring fillings as the new diagnostic standards required. Subsequently, Ludwig reported to the Department on which dental nurses were and were not 'co- operating'. The problem was also discussed with private dental practitioners in the two towns.

Most of the permanent tooth fillings for 6- and 7-year-old children were in the

Submission No: 1064

"occlusal surfaces of molars" mentioned above. This change in diagnostic procedure followed much discussion within the Fluoridation Committee. In 1954, it had been agreed to instruct school dental nurses in Hastings and Napier to cease inserting 'prophylactic fillings' - that is, small fillings placed, as a preventive measure, in pre- carious (not decayed but considered likely to decay) fissures on the occlusal (biting) surfaces of permanent molar teeth - and also to discontinue applying fluoride solution topically. In a report sent to the Committee in 1957 entitled ''Effect of prophylactic fillings and examination criteria on the results to be expected from fluoridation" a Dental Faculty member recommended "a re-evaluation of the criteria now used in deciding when a cavity should be filled" and "that no cavity should be filled until the lesion has penetrated the enamel." It was originally intended to record changing decay rates in both Hastings and Napier so that the difference between them would show the fluoride effect.

There can be no doubt that Ludwig and the Committee members sincerely believed, in the authors' view correctly, that dental nurses and private dentists were filling many teeth which should not definitely be classed as 'carious'. They also believed that such a meticulous filling practice could prevent a fair test of fluoridation in Hastings. But the change in diagnostic standard which they implemented must have contributed substantially to the reductions reported. Ludwig measured caries prevalence using the 'DMF' measure (average number of decayed missing and filled teeth). Because the children examined, like all children in New Zealand at that time, had been receiving regular six-monthly dental treatments, the measure was largely of the number of fillings. Thus the first recorded DMF scores consisted largely of a count of fillings which had been inserted using the earlier criteria for finding cavities.

It is clear that the results eventually published, for Hastings only, claiming to show the effect of water fluoridation, were partly if not mainly the result of the change in diagnostic procedure. The 6- and 7-year-olds, whose occlusal surfaces of molars were in 1594 filled much earlier and more often, would be the most affected by the change and showed the greatest reductions. Also, smooth tooth- surface cavities ('approximal' or between-teeth and 'gingival' or near-the-gum) reported by Ludwig and later by Backer Dirks to be the most reduced by fluoridation, were similarly in 1954 filled much earlier than the stage of ''penetration of the

Submission No: 1064

enamel'' described above. In none of the published papers on the Hastings study was the change in diagnostic standards reported. No explanation has been offered for that omission.

Limit of Credibility

The claimed large reductions in Hastings are beyond what is today regarded as the ''limit of credibility" for genuine reductions in decay prevalence. According to Alman (Journal of Dental Research, vol. 61 special, p.1361), annualized reduction rate of 10 to 12 per cent becomes an ''upper limit of credibility" and rates well above ten per cent suggest that we may be looking at a data-set-dependency, where the high level of change may combine true changes in caries prevalence with factors relating to changes in the population sampled or with inadvertent changes in diagnostic standards''. The annualized rate is not the percentage over a period divided by the number of years, but is the rate for each single year which would result, when calculated like compound interest, in the percentage reduction over that period. In the Hastings study the spectacular reductions, for 5- to 7-y~olds were mostly beyond the limit of credibility, annualised rates varying between 13 per cent and 20 per cent.

Ludwig reported, in each published part of his study, the total reduction since 1954 for each age group, which was very impressively expressed as a percentage. Thus in each later report it was not clear that many reductions since the previous report were quite small, after the first big ones (Figure 1). These large reductions carried through to some extent as the children grew older. The effect is shown in Figure 2 (In Figure 1 the 6- to 8-year-olds in the first stage became the 8- to 10-year-olds in the next stage, 2+ years later). A part of the carried-through difference must have been due to a real decay decline, now known to be occurring everywhere. The change in diagnosis, rather fluoridation, explains the big early reductions.

Those big reductions were rather deceptive. Obviously, delaying one filling in a 6- or 7-year-old, whose DMF has reached only 2 or 3, can result in a 30 to 50 per cent reduction. But by the time the child is 15 or 16, with a much higher DMF, the reduction carried through was a much smaller percentage. Thus the difference between the 6-year-old DMFs in Figure 2 is 74 per cent, while the carried-through

Submission No: 1064

reduction in the two DMFs by the time the children reached 15, is only 13 per cent for the 6.5 year period - an annualised decline of 2 per cent.

Figures 1 & 1A

Figure 1. Graph compiled from published results of reductions in dmf and DMF teeth, and in percentages with decay, of younger Hastings children between 1954 and 1964. The national reduction in 5-year-old dental decay (dmf and percent with decay) is also shown. Early steep declines, after the changed method of diagnosing for fillings, were followed by declines of similar steepness to that occurring for 5- year-olds throughout new Zealand without water fluoridation.

Dotted Lines: the percentage of 5-year-olds with decayed teeth (100 percent caries free). Solid Lines: the average number of decayed, missing and filled teeth ('dmf' primary teeth of five-year-olds, and 'DMF' permanent teeth of 6- to 10-year-olds).

Figure 2

Submission No: 1064

Figure 2: The increase in mean DMFT (decayed, missing and filled teeth) of groups of children as they grow older after their fist examination in the study. The suddenly lowered DMFT carried through and 9 or 10 years later was similar to the gradual 5- year-old decline elsewhere. Subjects for the study were all available Hastings schoolchildren of European extraction aged 5 to 16 years (except in 1970) who had lived in the city and consumed fluoridated water throughout life. Number in each age group varied from 259 (5-year) to 24 (16-year). The groups were thus approximately the same children between 1954 and 1970, though reducing in number with some overlapping of content of the groups in intervening years. Figure 2 is compiled from the published results for those children who were examined at age 6 or 7 years and again at 15 or 16 years. Source: Ludwig, op. cit.

Decay reduction in non-fluoridated Places

A reduction in dental decay of primary teeth at an annualised rate around 4 per cent, shown by continuously collected statistics for 5-year-olds (Health Department Annual Reports, 1956-1971 and NZ Dental Journal vol. 48, p.160, vol. 80, p.14), has occurred throughout New Zealand over the past 50 years (see Figure 1A). An equally steep though less continuously recorded decline in 12-13-year-olds' permanent tooth decay has also occurred, in recent years slightly steeper in non- fluoridated areas (Fulton, WHO monograph no 4, 1951. Health Department Annual Report, 1984)

In 1962 the Director of the Dental Division of the Health Department, Dr Leslie, in response to a request for dental clinic statistics showing the reported spectacular effects of fluoridation, wrote to the Fluoridation Committee. From dental records of the entire primary school population of New Zealand, he was unable to produce convincing figures showing an advantage from Hastings fluoridation. The 'simple method' he hoped for seems to have been devised. Population dental figures which would have shown relative effects of fluoridation, like those for 5-year-olds, were not collected, and were discontinued for 5year-olds ever since, only selected sample statistics have been presented to defend fluoridation.

For Hastings, two articles compared the filling rates in Hastings with other patient

Submission No: 1064

groups without fluoridation experience (NZ School Dental Service Gazette, vol. 24, p.55, NZ Dental Journal, vol. 62, p.32). In these studies there was no consideration of socioeconomic or ethnic differences between the Hastings and the other groups, nor of differences in decay prevalences between the groups before Hastings was fluoridated.

In explanation of Dr Leslie's letter, it is now conceded that there was a reduction in dental decay occurring in New Zealand, over and above the fluoridation effect, during the time of the Hastings study, although treatment records cannot be considered a satisfactory epidemiological tool (D.J. Beck letter to J.C.). However, one would have expected a dental decay reduction of 74 per cent claimed to have resulted from Hastings fluoridation by 1961, to be reflected in treatment requirements.

The Department's dental research officer found the same difficulty for Havelock North which was fluoridated along with Hastings, and stated of the years 1955 to 1961. "There has been a reduction in the caries incidence for all New Zealand in this period''. He concluded: "It is recommended that an investigation into the effect of fluoridation in Havelock North not be carried out." (File 124/30/33, May21, 1965).

No 'before and after' studies, using controls, have ever been carried out to demonstrate the effectiveness of water fluoridation under New Zealand conditions.

Napier Reduction

According to Fuller. (Letter to J.C.), surveys by Ludwig of Napier children in 1957 and 1961 showed that the change in diagnostic criteria had reduced filling rates only slightly there, indicating that the Hastings reductions were due mainly to fluoridation. Only the 1957 results of those surveys seem to leave been published (Soil Science, vol. 92, p.359). Abandonment of Napier as a control after 1957, and consequent lifting of pressure on school dental operators to delay fillings, would have resulted in the national reduction being less evident in Napier between 1957 and 1961. Dental clinic records examined by one author (National collection of School Dental Service patient history charts, Department of Health, Wellington) suggest that the overall

Submission No: 1064

Napier reduction, over a longer period than the brief one observed by Ludwig, was comparable to the national one (see Figure 3).

Figure 3: Napier decay reductions. Declines in mean number of decayed, missing and filled teeth (dmf, 5-year-olds, broken line) and permanent teeth (DMF, 7- to 10- year-olds, solid lines) between 1944 and 1960. The overall downward trends are similar to the national decline in dmf for 5-year-olds. Source: 259 dental history charts from Napier school dental clinics. In later part of the period older children were treated by private dentists.

Who was Right?

The discovery revealed by Ludwig's initial dental surveys in the two towns - that younger children, the ones expected to show the greatest benefit from fluoride, had up to 58 per cent less decay in the un-fluoridated control town - caused considerable embarrassment. The explanation - a trace element in Napier soil causing below average decay there (Nature, vol. 186, p695) - was simply not believed by the opponents of fluoridation. The discovery of the decay difference was not made until well after fluoridation had commenced. It was alleged by opponents that fluoride must have damaged Hastings children 5 teeth. The subsequently published figures on the dental status of virtually the entire 5-year-old population of New Zealand show that Ludwig's published figures for Napier 5-year-olds' dental health at that time (Soil Science, vol. 92, p359) were not below the national average. But the decay prevalence of Hastings 5-yearolds was well above average.

Early Doubts

The reason for the initial surveys being undertaken after fluoridation had commenced was the replacement of Hewat. The experiment had been commenced by him in 1952, when he carried out pre-fluoridation dental examinations of Hastings children. The results were not published. They are not in Department of Health files. Fuller,

Submission No: 1064

when he sought to examine them years later, found they had been destroyed in one of the Department's ''periodical purges of records" (letter J.C.). The Medical Research Council whose records at that period were held by the Department of Health, has none on the Hastings experiment. As well as the rather crude and subjectively influenced DMF measure used in United States studies and later by Ludwig, Hewat used a more precise and complex 'caries index' and 'annual caries attack rate', based on the proportion of tooth surfaces diseased after allowing for their period of exposure since eruption (Hewat and Eastcott, Dental Caries in New Zealand, Medical Research Council of New Zealand, 1955). Following the replacement of Hewat, there was in 1954 a complete new start. According to Fuller, Ludwig "simply could not calibrate against Hewat''

Although willing to submit fluoride to a fair trial, Hewat had doubts. In private memoranda he pointed out to his colleagues that an earlier survey had shown that children residing in natural fluoride areas of New Zealand (0.2 or more parts per million) did not have significantly less dental decay, and sometimes had significantly more. He stated: ''In spite of the fact that there is a steady increase in the number of communities in USA which are adopting fluoridation (over 400 recently), there is still doubt in my mind whether the benefit claimed to result from this measure is fully supported by scientific evidence. In New Zealand, we have found that many factors are interrelated with the caries rate, and I am not aware that any consideration has been given to such influences in the published data on caries and fluorine'' (Memo., Mar. 14, 1953 on file 125/299).

Professional Behaviour

The obvious possibility jumped at by opponents, that fluoride had actually damaged teeth of younger children, seems never to have been entertained by those conducting the experiment. They had faith in their theory that fluoridation would provide an immense benefit, based on their acceptance of evidence from the United States. The experiment was conducted in an atmosphere of intense public debate. Sir Dove Myer Robinson, for many years Mayor of Auckland and a prominent opponent of fluoridation, described the Hastings experiment as a 'swindle'. That view is understandable. But there is no doubt about the good intentions and sincere

Submission No: 1064

commitment of the professionals who conducted the experiment. Their ways of thinking and behaving are shared with other professions and have been the subject of sociological inquiry in other contexts (eg. "Professional Networks and the Institutionalisation of a Single Mind Set'', American Sociological Review, vol.50, p.639). There was no conscious effort to deceive, because the first deception was of themselves. Some of their actions are difficult to explain or condone. One was the calling in of the police to investigate secretly the backgrounds and political affiliations of persons organising opposition to fluoridation. Apparently the professionals on the Fluoridation Committee were unable to understand that their opponents could have other than sinister motives. The result of their inquiry, in a letter from Head Office, no doubt left them mystified

When the 1963 Hastings results were announced they drew comment from Hewat, then living in retirement (File 124/30/33, Apr. 27, 1965). He agreed, with the retired High School principal who had vigorously opposed Hastings fluoridation, that the results as presented could be interpreted differently, to show only a temporary delay in the onset of decay, with no reduction in the progress of the disease. Fuller and Ludwig, supported by the Government Statistician, rejected such an explanation (same File, May 19, 1965). The information now available, presented in this study, reinforces Hewat's assessment, which could explain why by 1962 Hastings children, as Dr Leslie had discovered, were receiving as many fillings as in other places where overall prevalence of the disease was also declining.

At the time Fuller commented: "I think we all realise this is largely a question of point of view and unfortunately Dr Hewat does not see it from the viewpoint of a fluoridationist (same file, Apr. 30, l965). Those who are committed to strong belief in a theory can interpret data and arrive at conclusions quite opposite to the conclusions of those who are not so committed. The history of science has repeatedly demonstrated that more than one theoretical construction can usually he placed upon a given collection of data. It is apparent that belief in, and commitment to the fluoridation paradigm, strongly influenced New Zealand health professionals in their interpretation or the Hastings data. Many of the participants in the above events are still living. They have been invited to comment on this new information.

Submission No: 1064

"The obvious possibility jumped at by opponents, that fluoride had actually damaged teeth of younger children, seems never to have been entertained by those conducting the experiment."

Conclusion

From the above considerations, it seems clear that the Hastings fluoridation study did not, as it was purported to do, demonstrate the effectiveness of water fluoridation in reducing dental decay in a typical New Zealand population. The reported reductions were at least partly, if not wholly, the result of factors other than fluoridation. Today, proponents or fluoridation will concede that there were other factors operating to cause the reductions, over and above any fluoridation effect. But that fact, although known to those responsible for the study, was never mentioned in official and scientific published reports on it. The study was, it seems, more a public relations exercise than a scientific one. Nonetheless, it is still cited in dental scientific literature, and in textbooks like Professor Murray's, as being the latter. We suggest closer examination of past fluoridation studies in other countries, as begun by Diesendorf (Nature, vol. 322, 125-l29, 10 July, 1986).

Submission No: 1064

Why I Changed My Mind About Water Fluoridation

John Colquhoun

To explain how I came to change my opinion about water fluoridation, I must go back to when I was an ardent advocate of the procedure. I now realize that I had learned, in my training in dentistry, only one side of the scientific controversy over fluoridation.

I had been taught, and believed, that there was really no scientific case against fluoridation, and that only misinformed lay people and a few crackpot professionals were foolish enough to oppose it I recall how, after I had been elected to a local government in Auckland (New Zealand’s largest city, where I practised dentistry for many years and where I eventually became the Principal Dental Officer) I had fiercely — and, I now regret, rather arrogantly — poured scorn on another Council member (a lay person who had heard and accepted the case against fluoridation) and persuaded the Mayor and majority of my fellow councillors to agree to fluoridation of our water supply.

A few years later, when I had become the city’s Principal Dental Officer, I published a paper in the New Zealand Dental Journal that reported how children’s tooth decay had declined in the city following fluoridation of its water, to which I attributed the decline, pointing out that the greatest benefit appeared to be in low-income areas [1]. My duties as a public servant included supervision of the city’s school dental clinics, which were part of a national School Dental Service which provided regular six- monthly dental treatment, with strictly enforced uniform diagnostic standards, to almost all (98 percent) school children up to the age of 12 or 13 years. I thus had access to treatment records, and therefore tooth decay rates, of virtually all the city’s children. In the study I claimed that such treatment statistics “provide a valid measure of the dental health of our child population” [1]. That claim was accepted by my professional colleagues, and the study is cited in the official history of the New Zealand Dental Association [2].

INFORMATION CONFIDED

I was so articulate and successful in my support of water fluoridation that my public service superiors in our capital city, Wellington, approached me and asked me to make fluoridation the subject of a world study tour in 1980 — after which I would become their expert on fluoridation and lead a campaign to promote fluoridation in those parts of New Zealand which had resisted having fluoride put into their drinking water.

Before I left on the tour my superiors confided to me that they were worried about some new evidence which had become available: information they had collected on the amount of treatment children were receiving in our school dental clinics seemed

Submission No: 1064

to show that tooth decay was declining just as much in places in New Zealand where fluoride had not been added to the water supply. But they felt sure that, when they had collected more detailed information, on all children (especially the oldest treated, 12-13 year age group) from all fluoridated and allnonfluoridated places [3] — information which they would start to collect while was I away on my tour — it would reveal that the teeth were better in the fluoridated places: not the 50 to 60 percent difference which we had always claimed resulted from fluoridation, but a significant difference nonetheless. They thought that the decline in tooth decay in the nonfluoridated places must have resulted from the use of fluoride toothpastes and fluoride supplements, and from fluoride applications to the children’s teeth in dental clinics, which we had started at the same time as fluoridation. Being a keen fluoridationist, I readily accepted their explanation. Previously, of course, we had assured the public that the only really effective way to reduce tooth decay was to add fluoride to the water supply.

WORLD STUDY TOUR

My world study tour took me to North America, Britain, Europe, Asia, and Australia [4]. In the United States I discussed fluoridation with Ernest Newbrun in San Francisco, Brian Burt in Ann Arbor, dental scientists and officials like John Small in Bethesda near Washington, DC, and others at the Centers for Disease Control in Atlanta. I then proceeded to Britain, where I met Michael Lennon, John Beale, Andrew Rugg-Gunn, and Neil Jenkins, as well as many other scientists and public health officials in Britain and Europe. Although I visited only pro-fluoridation research centers and scientists, I came across the same situation which concerned my superiors in New Zealand. Tooth decay was declining without water fluoridation. Again I was assured, however, that more extensive and thorough surveys would show that fluoridation was the most effective and efficient way to reduce tooth decay. Such large-scale surveys, on very large numbers of children, were nearing completion in the United States, and the authorities conducting them promised to send me the results.

LESSON FROM HISTORY

I now realize that what my colleagues and I were doing was what the history of science shows all professionals do when their pet theory is confronted by disconcerting new evidence: they bend over backwards to explain away the new evidence. They try very hard to keep their theory intact — especially so if their own professional reputations depend on maintaining that theory. (Some time after I graduated in dentistry almost half a century ago, I also graduated in history studies, my special interest being the history of science — which may partly explain my re- examination of the fluoridation theory ahead of many of my fellow dentists.)

So I returned from my study tour reinforced in my pro-fluoridation beliefs by these reassurances from fluoridationists around the world. I expounded these beliefs to my superiors, and was duly appointed chairman of a national “Fluoridation Promotion Committee.” I was instructed to inform the public, and my fellow professionals, that water fluoridation resulted in better children’s teeth, when compared with places with no fluoridation.

Submission No: 1064

Surprise: Teeth Better Without Fluoridation?

Before complying, I looked at the new dental statistics that had been collected while I was away for my own Health District, Auckland. These were for all children attending school dental clinics — virtually the entire child population of Auckland. To my surprise, they showed that fewer fillings had been required in the nonfluoridated part of my district than in the fluoridated part. When I obtained the same statistics from the districts to the north and south of mine — that is, from “Greater Auckland,” which contains a quarter of New Zealand’s population — the picture was the same: tooth decay had declined, but there was virtually no difference in tooth decay rates between the fluoridated and non fluoridated places. In fact, teeth were slightly better in the nonfluoridated areas. I wondered why I had not been sent the statistics for the rest of New Zealand. When I requested them, they were sent to me with a warning that they were not to be made public. Those for 1981 showed that in most Health Districts the percentage of 12- and 13-year-old children who were free of tooth decay – that is, had perfect teeth – was greater in the non-fluoridated part of the district. Eventually the information was published [4].

Over the next few years these treatment statistics, collected for all children, showed that, when similar fluoridated and non-fluoridated areas were compared, child dental health continued to be slightly better in the non-fluoridated areas [5,6]. My professional colleagues, still strongly defensive of fluoridation, now claimed that treatment statistics did not provide a valid measure of child dental health, thus reversing their previous acceptance of such a measure when it had appeared to support fluoridation.

I did not carry out the instruction to tell people that teeth were better in the fluoridated areas. Instead, I wrote to my American colleagues and asked them for the results of the large-scale surveys they had carried out there. I did not receive an answer. Some years later, Dr John Yiamouyiannis obtained the results by then collected by resorting to the U.S. Freedom of Information Act, which compelled the authorities to release them. The surveys showed that there is little or no differences in tooth decay rates between fluoridated and nonfluoridated places throughout America [7]. Another publication using the same database, apparently intended to counter that finding, reported that when a more precise measurement of decay was used, a small benefit from fluoridation was shown (20 percent fewer decayed tooth surfaces, which is really less than one cavity per child) [8]. Serious errors in that report, acknowledged but not corrected, have been pointed out, including a lack of statistical analysis and a failure to report the percentages of decay-free children in the fluoridated and nonfluoridated areas [7].

Other large-scale surveys from United States, from Missouri and Arizona, have since revealed the same picture: no real benefit to teeth from fluoride in drinking water [9, 10]. For example, Professor Steelink in Tucson, AZ, obtained information on the dental status of all schoolchildren – 26,000 of them – as well as information on the fluoride content of Tucson water [10]. He found: “When we plotted the incidence of

Submission No: 1064

tooth decay versus fluoride content in a child’s neighborhood drinking water, a positive correlation was revealed. In other words, the more fluoride a child drank, the more cavities appeared in the teeth” [11].

From other lands — Australia, Britain, Canada, Sri Lanka, Greece, Malta, Spain, Hungary, and India — a similar situation has been revealed: either little or no relation between water fluoride and tooth decay, or a positive one (more fluoride, more decay) [12-17]. For example, over 30 years Professor Teotia and his team in India have examined the teeth of some 400,000 children. They found that tooth decay increases as fluoride intake increases. Tooth decay, they decided, results from a deficiency of calcium and an excess of fluoride [17].

CAUSE OF DECLINE IN TOOTH DECAY

At first I thought, with my colleagues, that other uses of fluoride must have been the main cause of the decline in tooth decay throughout the western world. But what came to worry me about that argument was the fact that, in the nonfluoridated part of my city, where decay had also declined dramatically, very few children used fluoride toothpaste, many had not received fluoride applications to their teeth, and hardly any had been given fluoride tablets. So I obtained the national figures on tooth decay rates of five-year-olds from our dental clinics which had served large numbers of these children from the 1930s on [18]. They show that tooth decay had started to decline well before we had started to use fluorides (Fig. 1). Also, the decline has continued after all children had received fluoride all their lives, so the continuing decline could not be because of fluoride. The fewer figures available for older children are consistent with the above pattern of decline [18]. So fluorides, while possibly contributing, could not be the main cause of the reduction in tooth decay.

Figure 1

Submission No: 1064

(reproduced by Fluoride Action Network)

So what did cause this decline, which we find in most industrialized countries? I do not know the answer for sure, but we do know that after the second world war there was a rise in the standard of living of many people. In my country there has been a tremendous increase in the consumption of fresh fruit and vegetables since the 1930s, assisted by the introduction of household refrigerators [19]. There has also been an eightfold increase in the consumption per head of cheese, which we now know has anti-decay properties [19, 20]. These nutritional changes, accompanied by a continuing decline in tooth decay, started before the introduction of fluorides.

The influence of general nutrition in protection against tooth decay has been well described in the past [21], but is largely ignored by the fluoride enthusiasts, who insist that fluorides have been the main contributor to improved dental health. The increase in tooth decay in third-world countries, much of which has been attributed to worsening nutrition [22], lends support to the argument that improved nutrition in developed countries contributed to improved dental health.

FLAWED STUDIES

The studies showing little if any benefit from fluoridation have been published since 1980. Are there contrary findings? Yes: many more studies, published in dental professional journals, claim that there is a benefit to teeth from water fluoride. An example is a recent study from New Zealand [23], carried out in the southernmost area of the country [23]. Throughout New Zealand there is a range of tooth decay

Submission No: 1064

rates, from very high to very low, occurring in both fluoridated and nonfluoridated areas. The same situation exists in other countries.

What the pro-fluoride academics at our dental school did was to select from that southern area four communities: one nonfluoridated, two fluoridated, and another which had stopped fluoridation a few years earlier. Although information on decay rates in all these areas was available to them, from the school dental service, they chose for their study the one non-fluoridated community with the highest decay rate and two fluoridated ones with low decay rates, and compared these with the recently stopped fluoridated one, which happened to have medium decay rates (both before and after it had stopped fluoridation). The teeth of randomly selected samples of children from each community were examined. The chosen communities, of course, had not been randomly selected. The results, first published with much publicity in the news media, showed over 50 percent less tooth decay in the fluoridated communities, with the recently defluoridated town in a “middle” position (see left side of Fig. 2). When I obtained the decay rates for all children in all the fluoridated and all the nonfluoridated areas in that part of New Zealand, as well as the decay rates for all children in the recently defluoridated town, they revealed that there are virtually no differences in tooth decay rates related to fluoridation (see right side of Fig. 2).

When I confronted the authors with this information, they retorted that the results of their study were consistent with other studies. And of course it is true that many similar studies have been published in the dental professional literature. It is easy to see how the consistent results are obtained: an appropriate selection of the communities being compared. There is another factor: most pro-fluoridation studies (including this New Zealand one) were not “blind” — that is, the examiners knew which children received fluoride and which did not. Diagnosis of tooth decay is a very subjective exercise, and most of the examiners were keen fluoridationists, so it is easy to see how their bias could affect their results. It is just not possible to find a blind fluoridation study in which the fluoridated and nonfluoridated populations were similar and chosen randomly.

EARLY FLAWED STUDIES

One of the early fluoridation studies listed in the textbooks is a New Zealand one, the “Hastings Fluoridation Experiment” (the term “experiment” was later dropped because the locals objected to being experimented on) [24]. I obtained the Health Department’s fluoridation files under my own country’s “Official Information” legislation. They revealed how a fluoridation trial can, in effect, be rigged [25]. The school dentists in the area of the experiment were instructed to change their method of diagnosing tooth decay, so that they recorded much less decay after fluoridation began. Before the experiment they had filled (and classified as “decayed”) teeth with any small catch on the surface, before it had penetrated the outer enamel layer.After the experiment began, they filled (and classified as “decayed”) only teeth with cavities which penetrated the outer enamel layer. It is easy to see why a sudden drop in the numbers of “decayed and filled” teeth occurred. This change in method of diagnosis was not reported in any of the published accounts of the experiment.

Another city, Napier, which was not fluoridated but had otherwise identical drinking water, was at first included in the experiment as an “ideal control” — to show how

Submission No: 1064

tooth decay did not decline the same as in fluoridated Hastings. But when tooth decay actually declined more in the non-fluoridated control city than in the fluoridated one, in spite of the instructions to find fewer cavities in the fluoridated one, the control was dropped and the experiment proceeded with no control. (The claimed excuse was that a previously unknown trace element, molybdenum, had been discovered in some of the soil of the control city, making tooth decay levels there unusually low [26], but this excuse is not supported by available information, from the files or elsewhere, on decay levels throughout New Zealand).

The initial sudden decline in tooth decay in the fluoridated city, plus the continuing decline which we now know was occurring everywhere else in New Zealand, were claimed to prove the success of fluoridation. These revelations from government files were published in the international environmental journal, The Ecologist, and presented in 1987 at the 56th Congress of the Australian and New Zealand Association for the Advancement of Science [27].

When I re-examined the classic fluoridation studies, which had been presented to me in the text books during my training, I found, as others had before me, that they also contained serious flaws [28-30]. The earliest set, which purported to show an inverse relationship between tooth decay prevalence and naturally occurring water fluoride concentrations, are flawed mainly by their nonrandom methods of selecting data. The later set, the “fluoridation trials” at Newburgh, Grand Rapids, Evanston, and Brantford, display inadequate baselines, negligible statistical analysis, and especially a failure to recognize large variations in tooth decay prevalence in the control communities. We really cannot know whether or not some of the tooth decay reductions reported in those early studies were due to water fluoride.

I do not believe that the selection and bias that apparently occurred was necessarily deliberate. Enthusiasts for a theory can fool themselves very often, and persuade themselves and others that their activities are genuinely scientific. I am also aware that, after 50 years of widespread acceptance and endorsement of fluoridation, many scholars (including the reviewers of this essay) may find it difficult to accept the claim that the original fluoridation studies were invalid. That is why some of us, who have reached that conclusion, have submitted an invitation to examine and discuss new and old evidence “in the hope that at least some kind of scholarly debate will ensue” [31].

However, whether or not the early studies were valid, new evidence strongly indicates that water fluoridation today is of little if any value. Moreover, it is now widely conceded that the main action of fluoride on teeth is a topical one (at the surface of the teeth), not a systemic one as previously thought, so that there is negligible benefit from swallowing fluoride [32].

Harm from Fluoridation

The other kind of evidence which changed my mind was that of harm from fluoridation. We had always assured the public that there was absolutely no possibility of any harm. We admitted that a small percentage of children would have a slight mottling of their teeth, caused by the fluoride, but this disturbance in the formation of tooth enamel would, we asserted, be very mild and was nothing to worry

Submission No: 1064

about. It was, we asserted, not really a sign of toxicity (which was how the early literature on clinical effects of fluoride had described it) but was only at most a slight, purely cosmetic change, and no threat to health. In fact, we claimed that only an expert could ever detect it.

HARM TO TEETH

So it came as a shock to me when I discovered that in my own fluoridated city some children had teeth like those in Fig. 3. This kind of mottling answered the description of dental fluorosis (bilateral diffuse opacities along the growth lines of the enamel). Some of the children with these teeth had used fluoride toothpaste and swallowed much of it. But I could not find children with this kind of fluorosis in the nonfluoridated parts of my Health District, except in children who had been given fluoride tablets at the recommended dose of that time.

I published my findings: 25 percent of children had dental fluorosis in fluoridated Auckland and around 3 percent had the severer (discolored or pitted) degree of the condition [33]. At first the authorities vigorously denied that fluoride was causing this unsightly mottling. However, the following year another Auckland study, intended to discount my finding, reported almost identical prevalences and severity, and recommended lowering the water fluoride level to below 1 ppm [34]. Others in New Zealand and the United States have reported similar findings. All these studies were reviewed in the journal of the International Society for Fluoride Research [35]. The same unhappy result of systemic administration of fluoride has been reported in children who received fluoride supplements [36]. As a result, in New Zealand as elsewhere, the doses of fluoride tablets were drastically reduced, and parents were warned to reduce the amount of fluoride toothpaste used by their children, and to caution them not swallow any. Fluoridationists would not at first admit that fluoridated water contributed to the unsightly mottling — though later, in some countries including New Zealand, they also recommended lowering the level of fluoride in the water. They still insist that the benefit to teeth outweighs any harm.

WEAKENED BONES

Common sense should tell us that if a poison circulating in a child’s body can damage the tooth-forming cells, then other harm also is likely. We had always admitted that fluoride in excess can damage bones, as well as teeth.

By 1983 I was thoroughly convinced that fluoridation caused more harm than good. I expressed the opinion that some of these children with dental fluorosis could, just possibly, have also suffered harm to their bones [Letter to Auckland Regional Authority, January 1984]. This opinion brought scorn and derision: there was absolutely no evidence, my dental colleagues asserted, of any other harm from low levels of fluoride intake, other than mottling of the teeth.

Six years later, the first study reporting an association between fluoridated water and hip fractures in the elderly was published [37]. It was a large-scale one. Computerization has made possible the accumulation of vast data banks of information on various diseases. Hip fracture rates have increased dramatically, independently of the increasing age of populations. Seven other studies have now

Submission No: 1064

reported this association between low water fluoride levels and hip fractures [38-44]. Have there been contrary findings? Yes; but most of the studies claiming no association are of small numbers of cases, over short periods of time, which one would not expect to show any association [45, 46]. Another, comparing a fluoridated and a nonfluoridated Canadian community, also found an association in males but not in females, which hardly proves there is no difference in all cases [47]. Our fluoridationists claim that the studies which do show such an association are only epidemiological ones, not clinical ones, and so are not conclusive evidence.

But in addition to these epidemiological studies, clinical trials have demonstrated that when fluoride was used in an attempt to treat osteoporosis (in the belief it strengthened bones), it actually caused more hip fractures [48-52]. That is, when fluoride accumulates in bones, it weakens them. We have always known that only around half of any fluoride we swallow is excreted in our urine; the rest accumulates in our bones [53, 54]. But we believed that the accumulation would be insignificant at the low fluoride levels of fluoridated water. However, researchers in Finland during the 1980s reported that people who lived 10 years or more in that country’s one fluoridated city, Kuopio, had accumulated extremely high levels of fluoride in their bones — thousands of parts per million — especially osteoporosis sufferers and people with impaired kidney function [55, 56]. After this research was published, Finland stopped fluoridation altogether. But that information has been ignored by our fluoridationists.

BONE CANCER?

An association with hip fracture is not the only evidence of harm to bones from fluoridation. Five years ago, animal experiments were reported of a fluoride-related incidence of a rare bone cancer, called osteosarcoma, in young male rats [57]. Why only the male animals got the bone cancer is not certain, but another study has reported that fluoride at very low levels can interfere with the male hormone, testosterone [58]. That hormone is involved in bone growth in males but not in females.

This finding was dismissed by fluoridation promoters as only “equivocal evidence,” unlikely to be important for humans. But it has now been found that the same rare bone cancer has increased dramatically in young human males — teenage boys aged 9 to 19 — in the fluoridated areas of America but not in the nonfluoridated areas [59]. The New Jersey Department of Health reported osteosarcoma rates were three to seven times higher in its fluoridated areas than in its nonfluoridated areas [60].

Once again, our fluoridationists are claiming that this evidence does not “conclusively” demonstrate that fluoride caused the cancers, and they cite small- scale studies indicating no association. One study claimed that fluoride might even be protective against osteosarcoma [61]; yet it included only 42 males in its 130 cases, which meant the cases were not typical of the disease, because osteosarcoma is routinely found to be more common in males. Also, the case-control method used was quite inappropriate, being based on an assumption that if ingested fluoride was the cause, osteosarcoma victims would require higher fluoride exposure than those without the disease. The possibility that such victims might be more

Submission No: 1064

susceptible to equal fluoride exposures was ignored. All these counter-claims have been subjected to critical scrutiny which suggests they are flawed [62, 63]. Nonetheless, the pro-fluoride lobbyists continue to insist that water fluoridation should continue because, in their view, the benefits to teeth outweigh the possibility of harm. Many dispute that assessment.

OTHER EVIDENCE OF HARM

There is much more evidence that tooth mottling is not the only harm caused by fluoridated water. Polish researchers, using a new computerized method of X-ray diagnosis, reported that boys with dental fluorosis also exhibit bone structure disturbances [64]. Even more chilling is the evidence from China that children with dental fluorosis have on average lower intelligence scores [65, 66]. This finding is supported by a recently published animal experiment in America, which showed that fluoride also accumulated in certain areas of the brain, affecting behavior and the ability to learn [67].

Endorsements Not Universal

Concerning the oft-repeated observation that fluoridation has enjoyed overwhelming scientific endorsement, one should remember that even strongly supported theories have eventually been revised or replaced. From the outset, distinguished and reputable scientists opposed fluoridation, in spite of considerable intimidation and pressure [68, 69].

Most of the world has rejected fluoridation. Only America where it originated, and countries under strong American influence persist in the practice. Denmark banned fluoridation when its National Agency for Environmental Protection, after consulting the widest possible range of scientific sources, pointed out that the long-term effects of low fluoride intakes on certain groups in the population (for example, persons with reduced kidney function), were insufficiently known [70]. Sweden also rejected fluoridation on the recommendation of a special Fluoride Commission, which included among its reasons that: “The combined and long-term environmental effects of fluoride are insufficiently known” [71]. Holland banned fluoridation after a group of medical practitioners presented evidence that it caused reversible neuromuscular and gastrointestinal harm to some individuals in the population [72].

Environmental scientists, as well as many others, tend to doubt fluoridation. In the United States, scientists employed by the Environmental Protection Agency have publicly disavowed support for their employer’s pro-fluoridation policies [73]. The orthodox medical establishment, rather weak or even ignorant on environmental issues, persist in their support, as do most dentists, who tend to be almost fanatical about the subject. In English- speaking countries, unfortunately, the medical profession and its allied pharmaceutical lobby (the people who sell fluoride) seem to have more political influence than environmentalists.

Submission No: 1064

REFERENCES

1. Colquhoun J. The influence of social rank and fluoridation on dental treatment requirements. New Zealand Dental Journal 73 146-148 1977. 2. Brooking TWH. A History of Dentistry in New Zealand. Dunedin. New Zealand Dental Association 1980 pp 214-215. 3. Hollis MJ, Hunter PB. Official Instructions: Dental health statistics, Form II children. School Dental Service Gazette 41 (3) 19 1980. 4. Colquhoun J. New evidence on fluoridation. Social Science and Medicine 19 1239-1246 1984. 5. Colquhoun J. Influence of social class and fluoridation on child dental health. Community Dentistry and Oral Epidemiology 13 37-41 1985. 6. Colquhoun J. Child dental health differences in New Zealand. Community Health Studies 11 85-90 1987. 7. Yiamouyiannis JA. Water fluoridation and tooth decay: Results from the 1986- 1987 national survey of U.S. schoolchildren. Fluoride 23 55-67 1990. 8. Brunelle JA, Carlos JP Recent trends in dental caries in U. S. children and the effect of water fluoridation. Journal of Dental Research 69 (Special Issue) 723- 728 1990. 9. Hildebolt CF, Elvin-Lewis M, Molnar S et al. Caries prevalences among geochemical regions of Missouri. American Journal of Physical Anthropology 78 79-92 1989. 10. Jones T, Steelink C, Sierka J. Analysis of the causes of tooth decay in children in Tucson, Arizona. Paper presented at Annual Meeting of the American Association for the Advancement of Science, San Francisco, USA, February 1994. Abstract in Fluoride 27 (4) 238 1994. 11. Steelink C. Letter. Chemical and Engineering News 27 July 1992 pp 2-3. 12. Diesendorf M A re-examination of Australian fluoridation trials. Search 17 256- 261 1986. 13. Diesendorf M. Have the benefits of water fluoridation been overestimated? International Clinical Nutrition Review 10 292-303 1990. 14. Diesendorf M. The mystery of declining tooth decay. Nature 322 125-129 1986. 15. Gray A S. Fluoridation: Time for a new base line? Journal of the Canadian Dental Association 53 763-765 1987. 16. Ziegelbecker RC, Ziegelbecker R. WHO data on dental caries and natural water fluoride levels. Fluoride 26 263-266 1993. 17. Teotia SPS, Teotia M. Dental caries: a disorder of high fluoride and low dietary calcium interactions (30 years of personal research). Fluoride 27 59-66 1994. 18. Colquhoun J. Fluorides and the decline in tooth decay in New Zealand. Fluoride 26 125-134 1993. 19. Hamilton V, Birkbeck JA. The Home Style Survey of New Zealand‘s Changing Diet. Quality Bakers, Palmerston North 1985. 20. Herod EL. The effect of cheese on dental caries: A review of the literature. Australian Dental Journal 36 (2)120-125 1991. 21. Price WA. Nutrition and Physical Degeneration. Heuber, New York 1939. 22. Smith G. Tooth decay in the developing world: could a vaccine help prevent cavities? Perspectives in Biology and Medicine 31 440-453 1988.

Submission No: 1064

23. Treasure ET, Dever JG. The prevalence of caries in 5-year-old children living in fluoridated and non-fluoridated communities in New Zealand. New Zealand Dental Journal 88 9-13 1992. 24. Ludwig TG. The Hastings fluoridation project. New Zealand Dental Journal 54 165-172 1958. 55 176-179 1959. 58 22-24 1962 (co-author EIF Pearce). 59 298- 301 1963. 61 175-179 1965. 67 155-160 1971. 25. Department of Health files on fluoridation in National Archives, Wellington, New Zealand. Copies in possession of author and described in: Colquhoun J. Education and Fluoridation in New Zealand: An historical study (PhD dissertation, University of Auckland). University Microfilms International, Ann Arbor MI 1987. 26. Ludwig TG. Recent marine soils and resistance to dental caries. Australian Dental Journal 8 109-113 1963. 27. Colquhoun J, Mann R. The Hastings fluoridation experiment: Science or swindle? Ecologist 16 (6) 243-248 1986 17 (2) 125-126 1987. 28. Colquhoun J. Flawed foundation: A re-examination of the scientific basis for a dental benefit from fluoridation. Community Health Studies 14 288-296 1990. 29. Klerer M. The fluoridation experiment. Contemporary Issues 7 119-143 1956. 30. Sutton PRN. Fluoridation: Errors and Omissions in Experimental Trials. Melbourne University Press, Melbourne 1960. 31. Diesendorf M, Colquhoun J, Spittle B J et al. New evidence on fluoridation. Australian and New Zealand Journal of Public Health 21 187-190 1997. 32. Journal of Dental Research 69 (Special Issue) 606-613 742-750 556-557 1990. 33. Colquhoun J. Disfiguring dental fluorosis in Auckland, New Zealand. Fluoride 17 234-242 1984. 34. Cutress TW, Suckling GW, Pearce EIF, Ball ME. Defects in tooth enamel in children in fluoridated and non-fluoridated water areas of the Auckland Region. New Zealand Dental Journal 81 12-19 1985. 35. Colquhoun J. Disfiguring or “white and strong”? Fluoride 23 104-111 1990. 36. Aasenden R, Peebles TC. Effects of fluoride supplementation from birth on human deciduous and permanent teeth. Archives of Oral Biology 19 321-326 1974. 37. Jacobsen SJ, Goldberg J, Miles TP et al. Regional variation in the incidence of hip fracture among white women aged 65 years and older. Journal of the American Medical Association 264 500-502 1990. 38. Cooper C, Wickham CAC, Barker DJR, Jacobsen SJ. Letter. Journal of the American Medical Association 266 513-514 1991. 39. Jacobsen SJ, Goldberg J, Cooper C, Lockwood SA. The association between water fluoridation and hip fracture among white women and men aged 65 years and older. A national ecologic study. Annals of Epidemiology 2 617-626 1992. 40. Sowers MFR, Clark MK, Jannausch ML, Wallace RB. A prospective study of bone mineral content and fracture in communities with differential fluoride exposure. American Journal of Epidemiology 133 649-660 1991. 41. Jacqmin-Gadda H, Commenges D, Dartigues J-F. Fluorine concentration in drinking water and fractures in the elderly. Journal of the American Medical Association 273 775-776 1995. 42. Danielson C, Lyon JL, Egger M, Goodenough GK. Hip fractures and fluoridation in Utah’s elderly population. Journal of the American Medical Association 268 746-748 1992.

Submission No: 1064

43. Keller C. Fluorides in drinking water. Paper presented at Workshop on Drinking Water Fluoride Influence on Hip Fractures and Bone Health. Bethesda MD, April 10 1991. 44. May DS., Wilson MG. Hip fractures in relation to water fluoridation: an ecologic analysis. Paper presented at Workshop on Drinking Water Fluoride Influence on Hip Fractures and Bone Health. Bethesda MD, April 10, 1991. 45. Cauley JA, Murphy PA, Riley T, Black D. Public health bonus of water fluoridation: Does fluoridation prevent osteoporosis and its related fractures? American Journal of Epidemiology 134 768 1991. Abstract. 46. Jacobsen SJ, O’Fallon WM, Melton III IJ. Hip fracture incidence before and after fluoridation of the public water supply, Rochester, Minnesota. American Journal of Public Health83 743-745 1993. 47. Suarez-Almazor ME, Flowerdew G, Saunders LD et al. The fluoridation of drinking water and hip fracture hospitalization rates in 2 Canadian communities. American Journal of Public Health 83 689-693 1993. 48. Riggs BL, Hodgson SF, O’Fallon WM et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. New England Journal of Medicine 322 802-809 1990. 49. Kleerekoper M, Peterson E, Philips E et al. Continuous sodium fluoride therapy does not reduce vertebral fracture rate in postmenopausal osteoporosis. Journal of Bone and Mineral Research 4 (Suppl 1) S376 1989. Abstract. 50. Hedlund LR, Gallagher JC. Increased incidence of hip fracture in osteoporotic women treated with sodium fluoride. Journal of Bone and Mineral Research 4 223-225 1989. 51. Lindsay R. Fluoride and bone – quantity versus quality. New England Journal of Medicine 322 844-845 1990. 52. Melton LJ. Fluoride in the prevention of osteoporosis and fractures. Journal of Bone and Mineral Research 5 (Suppl 1) S163-S167 1990. 53. 53 Fluorides and Human Health. World Health Organization, Geneva 1970 pp 37-41. 54. 54 Fluorine and Fluorides. World Health Organization, Geneva 1984 pp 152- 153. 55. Alhava EM, Olkkomen H, Kauranen P, Kari T. The effect of drinking water fluoridation on the fluoride content, strength and mineral density of human bone. Acta Orthopædica Scandinavica 51 413-420 1980. 56. Arnala I, Alhava EM, Kauranen EM. Effects of fluoride on bone in Finland. histomorphometry of cadaver bone from low and high fluoride areas. Acta Orthopædica Scandinavica56 161-166 1985. 57. Maurer JK, Cheng MC, Boysen BG, Anderson RL. Two-year carcinogenicity study of sodium fluoride in rats. Journal, National Cancer Institute 82 1118-1126 1990. 58. Kanwar KC, Parminderjit SV, Kalla NR. In vitro inhibition of testosterone synthesis in the presence of fluoride ions. IRCS Medical Science 11 813-814 1983. 59. Hoover RN, Devesa S, Cantor K, Fraumeni Jr JF. Time trends for bone and joint cancers and osteosarcomas in the Surveillance, Epidemiology and End Results (SEER) Program, National Cancer Institute. In: Review of Fluoride: Benefits and Risks, Report of the Ad Hoc Committee on Fluoride of the Committee to Coordinate Environmental Health and Related Programs. US Public Health Service, 1991. F1-F7.

Submission No: 1064

60. Cohn PD. A brief report on the association of drinking water fluoridation and the incidence of osteosarcoma among young males. New Jersey Department of Health, November 8 1992. 61. Gelberg KH, Fitzgerald EF, Hwang S, Dubrow R. Fluoride exposure and childhood osteosarcoma: a case-control study. American Journal of Public Health 85 1678-1683 1995. 62. Lee JR. Review of report by K H Gelberg et al. Fluoride 29 237-240 1996. 63. Yiamouyiannis JA. Fluoridation and cancer. Fluoride 26 83-96 1993. 64. Chlebna-Sokol D, Czerwinski E. Bone structure assessment on radiographs of distal radial metaphysis in children with dental fluorosis. Fluoride 26 37-44 1993. 65. Li XS, Zhi JL, Gao RO. Effect of fluoride exposure on intelligence of children. Fluoride 28 189-192 1995. 66. Zhao LB, Liang GH, Zhang DN, Wu XR. Effect of a high fluoride water supply on children’s intelligence. Fluoride 29 190-192 1996. 67. Mullenix PJ, Denbesten PK, Schunior A, Kernan WJ. Neurotoxicity of sodium fluoride in rats. Neurotoxicology and Teratology 17 169-177 1995 (Cf. Editorial: Neurotoxicity of Fluoride. Fluoride 29 57-58 1996). 68. Martin B. Scientific Knowledge in Controversy: The Social Dynamics of the Fluoridation Debate. State University of New York Press, Albany NY 1991. 69. Waldbott GL, Burgstahler AW, McKinney HL. Fluoridation: The Great Dilemma. Coronado Press, Lawrence KS 1978. Chapter 18. 70. Nyt fra miljøstyrelsen (Newsletter of National Agency of Environmental Protection, Denmark). Special issue (in English), February, 1977. 71. Fluor i karies- förebyggande syfte (Report of Swedish Fluoride Commission). Statens Offentliga Utredningar, Stockholm 1981. English-language summary pp 21-30. 72. Grimbergen GW. A double blind test for determination of intolerance to fluoridated water (preliminary report). Fluoride 7 146-152 1974. 73. Hirzy W. Press releases. Fluoride 26 279-281 1993; Fluoride 30 258-259 1997.

* John Colquhoun School of Education, University of Auckland, Private Bag 92019, Auckland, New Zealand.

© 1997 by The University of Chicago Press. All rights reserved. First published in Perspectives in Biology and Medicine 41 29-44 1997 Reprinted with permission in Fluoride, Journal of the International Society for Fluoride Research. Editorial Office: 81A Landscape Road, Mount Eden, Auckland 1004, New Zealand

PERSPECTIVES IN BIOLOGY AND MEDICINE The purpose of this quarterly journal is to serve as a vehicle for articles which convey new ideas or stimulate original thought in the biological and medical sciences. Subscription information is available from the publisher: the University of Chicago Press, Journals Division, PO Box 37005, Chicago, IL 60637, USA.

Submission No: 1064

Fluoride & Intelligence: The 36 Studies

Fluoride Action Network | By Michael Connett & Tara Blank, PhD | UPDATED December 9, 2012

As of December 2012, a total of 42 studies have investigated the relationship between fluoride and human intelligence, and a total of 17 studies have investigated the relationship fluoride and learning/memory in animals. Of these investigations, 36 of the 42 human studies have found that elevated fluoride exposure is associated with reduced IQ, while 16 of the 17 animal studies have found that fluoride exposure impairs the learning and memory capacity of animals. The human studies, which are based on IQ examinations of over 11,000 children, provide compelling evidence that fluoride exposure during the early years of life can damage a child’s developing brain. After reviewing 27 of these studies, a team of Harvard scientists concluded that fluoride’s effect on the young brain should now be a “high research priority.” (Choi, et al 2012). Other reviewers have reached similar conclusions, including the prestigious National Research Council (NRC), and scientists in the Neurotoxicology Divisionof the Environmental Protection Agency (Mundy, et al). In the table below, we summarize the results from the 36 studies that have found associations between fluoride and reduced IQ and provide links to full-text copies of the studies. For a discussion of the 6 studies that did not find an association between fluoride and IQ, click here.

Quick Facts About the 36 Studies:

• Location of Studies: China (28), India (4), Iran (3), and Mexico (1). • Sources of Fluoride Exposure: Thirty of the thirty-six IQ studies involved communities where the predominant source of fluoride exposure was water; six studies investigated fluoride exposure from coal burning. • Fluoride Levels in Water: IQ reductions have been significantly associated with fluoride levels of just 0.88 mg/L among children with iodine deficiency. (Lin 1991) Other studies have found IQ reductions at 1.8 ppm (Xu 1994); 1.9 ppm (Xiang

Submission No: 1064

2003a,b); 0.3-3.0 ppm (Ding 2011); 2.0 ppm (Yao 1996, 1997); 2.1-3.2 ppm (An 1992); 2.38 ppm (Poureslami 2011); 2.45 ppm (Eswar 2011); 2.5 ppm (Seraj 2006); 2.85 ppm (Hong 2001); 2.97 ppm (Wang 2001, Yang 1994); 3.1 ppm (Seraj 2012); 3.15 ppm (Lu 2000); and 4.12 ppm (Zhao 1996). • Fluoride Levels in Urine: Eleven of the thirty-five IQ studies have provided data on the level of fluoride in the children’s urine. Seven of these eleven studies reported that the average urine fluoride level was below 4 mg/l, and five reported average fluoride levels below 3 mg/L. To put these levels in perspective, a study from England found that 5.6% of the adult population in fluoridated areas have urinary fluoride levels exceeding 3 mg/L, and 1.1% have levels exceeding 4 mg/L. (Mansfield 1999) Although there is an appalling absence of urinary fluoride data among children in the United States, the excess ingestion of fluoride toothpaste among some young children is almost certain to produce urinary fluoride levels that exceed 2 ppm in a portion of the child population.

Methodological Limitations As both the NRC and Harvard reviews have correctly pointed out, many of the fluoride/IQ studies have used relatively simple designs and have failed to adequately control for all of the factors that can impact a child’s intelligence (e.g., parental education, socioeconomic status, lead and arsenic exposure). For several reasons, however, it is extremely unlikely that these limitations can explain the association between fluoride and IQ.

First, some of the fluoride/IQ studies have controlled for the key relevant factors, and significant associations between fluoride and reduced IQ were still observed. This fact was confirmed in the Harvard review, which reported that the association between fluoride and IQ remains significant when considering only those studies that controlled for certain key factors (e.g., arsenic, iodine, etc). Indeed, the two studies that controlled for the largest number of factors (Rocha Amador 2007; Xiang 2003a,b) reported some of the largest associations between fluoride and IQ to date. Second, the association between fluoride and reduced IQ in children is predicted by, and entirely consistent with, a large body of other evidence. Other human studies, for example, have found associations between fluoride and neurobehavior in ways consistent with fluoride being a neurotoxin. In addition, animal studies have repeatedly found that fluoride impairs the learning and memory capacity of rats under carefully controlled laboratory conditions. An even larger body of animal research has found that fluoride can directly damage the brain, a finding that has been confirmed in studies of aborted human fetuses from high-fluoride areas. Finally, it is worth considering that before any of the studies finding reduced IQ in humans were known in the western world, a team of U.S. scientists at a Harvard-affiliated research center predicted (based on behavioral effects they observed in fluoride-treated animals) that fluoride might be capable of reducing IQ in humans. (Mullenix 1995)

Summary When considering their consistency with numerous animal studies, it is very unlikely that the 36 human studies finding associations between fluoride and reduced IQ can all be a random fluke. The question today, therefore, is less whether fluoride reduces IQ, but at what dose, at what time, and how this dose and time varies based on an individual’s nutritional status, health status, and exposure to other contaminants (e.g., aluminum, arsenic, lead, etc). Of particular concern is fluoride’s effect on children born to women with suboptimal iodine intake during the time of pregnancy, and/or fluoride’s effects on infants

Submission No: 1064

and toddlers with suboptimal iodine intake themselves. According to the U.S. Centers for Disease Control, approximately 12% of the U.S. population has deficient exposure to iodine. Studies Finding Association Between Fluoride & Reduced IQ:

IQ Study #36: Wang (2012)

Citation Wang G, et al. (2012). Total intake of fluorine content and children’s IQ. Southeast University Medical Sciences. Available at: http://www.cnki.com.cn/Article/CJFDTOTAL-NJTD201206020.htm

Location of Sihong County, Jiangsu Province, China. Study:

Age of 8 to 13 years old Subjects:

Source of Water, Food, Air. Fluoride:

Water Fluoride High-Fluoride: 0.57 to 4.5 mg/L Levels: Low-Fluoride: 0.18 to 0.76 mg/L

Total Daily 1 to 4+ mg/day. Fluoride Doses:

Results: (1) Average IQ of High F group (92.02 + 13.00) is significantly lower than average IQ of Low-F group (100.41 +13.21). (2) There are “marked dose-response relationships” between intelligence and the total daily intake of fluoride from all sources.

Conclusion: “High fluoride intake can have an impact on the development of children’s brains, resulting in decreased childhood IQ.”

IQ Study #35: Seraj (2012)

Citation: Seraj B, et al. (2012). Effect of high water fluoride concentration on the intellectual development of children in Makoo/Iran. Journal of Dentistry, Tehran University of Medical Sciences. 9(3): 221-29.

Location of Makoo, Iran. Study:

Submission No: 1064

Size of Study: 293 children (91 children in control village; 106 children in medium F village; 96 children in high F village)

Age of 6 to 11 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride Control = 0.8+0.3 ppm Levels: Medium fluoride = 3.1+0.9 ppm High fluoride = 5.2+1.1 ppm

Controls for Age, gender, child’s educational level, mother’s educational level, father’s Confounding educational level, fluorosis intensity, iodine level in water, lead level in water. Factors:

IQ Test: Raven’s Color Progressive Matrices (RCPM)

Results: “The mean IQ scores decreased from 97.77+18.91 for the normal fluoride group to 89.03+12.99 for the medium fluoride group and to 88.58+16.01 for the high fluoride group (P=0.001).”

Conclusion: ”Since all potentially confounding factors were adjusted, the difference in IQ scores may reveal the potential effect of high fluoride exposure on the intellectual development of children.”

IQ Study #34: Saxena (2012)

Citation: Saxena S, et al. (2012). Effect of fluoride exposure on the intelligence of school children in Madhya Pradesh, India. Journal of Neurosciences in Rural Practice 3(2):144-49.

Location of Madhya Pradesh, India. Study:

Size of Study: 173 children (120 children in three high-F areas and 53 children from a control group)

Age of School children in the 5th & 6th grades Subjects:

Source of Water Fluoride Exposure:

Water Fluoride Group 1 = >4.5 ppm Group 2 = 3.1-4.5 ppm

Submission No: 1064

Levels: Group 3 = 1.5-3.0 ppm Control = <1.5 ppm

Urine Fluoride Group 1 = 7.01+1.02 Levels: Group 2 = 4.85+0.50 Group 3 = 3.28+0.48 Control = 2.25+0.28

Controls for (1) No significant differences in urinary lead, arsenic, or iodine levels Confounding between the four groups. (2) No significant differences in gender ratio, socio- Factors: economic status, SES, parental education, height/age ratio, and weight/height ratio. (3) Children were excluded if they were not lifelong resident of area, if they had changed their water source since birth, or if they had history of congenital or acquired neurological disease and/or head injury.

IQ Test: Raven’s Standard Progressive Matrices

Results: ”Reduction in intelligence was observed with an increased water fluoride level (P 0.000). The urinary fluoride level was a significant predictor for intelligence (P 0.000).”

Conclusion: ”This study indicates that exposure to fluoride is associated with reduced intelligence in children. We have found a significant inverse relationship between intelligence and the water fluoride level, and intelligence and the urinary fluoride level. After adjusting for confounders, urinary fluoride was the significant predictor for intelligence.”

IQ Study #33: Ding (2011)

Citation: Ding Y, et al. (2011). The relationships between low levels of urine fluoride on children’s intelligence, dental fluorosis in endemic fluorosis areas in Hulunbuir, Inner Mongolia, China. Journal of Hazardous Materials 186(2- 3):1942-46.

Location of Hulunbuir, Inner Mongolia, China study:

Size of study: 331 children from four sites

Age of 7-14 years old Subjects:

Source of Water Fluoride:

Water Fluoride Mianduhe town=0.28+0.03 mg/L Levels: Nan district=0.79+0.33 mg/L Donghu district=1.78+0.60 mg/L

Submission No: 1064

Zhalainuoer county=1.82+1.00 mg/

Urine Fluoride No dental fluorosis = 0.80+0.55 mg/L Levels: Questionable fluorosis = 1.13+0.73 mg/L Very mild fluorosis = 1.11+0.74 mg/L Mild fluorosis = 1.31+0.78 mg/L Moderate fluorosis =1.46+0.79 mg/L.

Controls for (1) Sites selected to match social and natural factors like economic situation, Confounding educational standard, and geological environments. (2) Schools had similar Factors: teaching quality. (3) Sites are not exposed to known neurotoxins (e.g. arsenic) in drinking water, nor are they endemic areas for iodine deficiency disorders. (4) Five children who had not lived in these areas at least 1 year were excluded.

IQ Test: CRT-RC3 (Combined Raven’s Test for Rural China)

Results: Children’s IQ was inversely related to urinary fluoride content, (p<0.0001). Each increase in 1 mg/L of urine F was associated with 0.59 point decrease in IQ (p=0.0226).

Conclusion: “In conclusion, our study suggested that low levels of fluoride exposure in drinking water had negative effects on children’s intelligence and dental health and confirmed the dose-response relationships between urine fluoride and IQ scores as well as dental fluorosis.”

IQ Study #32: Poureslami (2011)

Citation: Poureslami HR, et al. (2011). Intelligence quotient of 7 to 9 year-old children from an area with high fluoride in drinking water. Journal of Dentistry and Oral Hygiene 3(4):61-64.

Location of Kerman Province, Iran: Koohbanan (high-F) and Baft (low-F) study:

Size of study: 120 children: 60 children per city

Age of 7-9 years old Subjects:

Source of Water Fluoride:

Water Fluoride High-F = 2.38 mg/L levels: Low-F = 0.41 mg/L

Controls for (1) Exclusion criteria: genetic, congenital, or acquired diseases related to the Confounding nervous system, past or present. (2) Inclusion criteria (high-F village): signs of grade III TSIDF (total surface index of Dental Fluorosis) or more. (3)

Submission No: 1064

Factors: Inclusion criteria (low-F village): similar physical and mental health criteria adopted, but children lacked any sign of Dental Fluorosis. (4) Both towns at high altitude.

Type of IQ Raven’s Progressive Matrices Intelligence Test (Persian version) Test

Results: Average IQ of High F group (91.37+16.63) is significantly lower than average IQ of Low-F group (97.80+15.95), p < 0.05.

Conclusion: “Based on the findings, chronic exposure to high levels of fluoride can be one of the factors that influence intellectual development.”

IQ Study #31: Eswar (2011)

Citation: Eswar P, et al. (2011). Intelligent quotients of 12-14 year old school children in a high and low fluoride village in India. Fluoride 44:168-72.

Location of Ajjihalli (low F) and Holesirigere (high F) villages, Davangere district, study: Karnataka, India.

Size of study: 133 children total (low F village=65; high F village=68)

Age of 12-14 years old Subjects:

Source of Water Fluoride:

Water Fluoride High F village=2.45 mg/L levels: Low F village =0.29 mg/L

Controls for (1) Children included were continuous residents of study villages since birth; Confounding drinking water from same public water supply (1 per village); (2) attended Factors: same high school (1 per village). (3) Children with history of trauma or injury to head; affected by congenital or acquired neurological disorders, psychological disorders were excluded.

Type of IQ Raven’s Standard Progressive Matrices Test Test

Results: 63.2% of children in high F area had IQ less than 90, versus 47.7% of children in low F village. (p=0.06).

Conclusion: “Though there was a trend in our study towards lower IQ in a greater number of children from high F village than in the low F village, probably the small sample size of the present study failed to establish a statistically significant difference.”

Submission No: 1064

IQ Study #30: Shivaprakash (2011)

Citation: Shivaprakash PK, et al. (2011). Relation between dental fluorosis and intelligence quotient in school children of Bagalkot district. J Indian Soc Pedod Prev Dent. 29(2):117-20.

Location of Bagalkot district, Karnataka state, India study:

Size of study: 160 children

Age of 7-11 years old Subjects:

Source of Water Fluoride:

Water Fluoride high F village = 2.5-3.5 mg/L Levels: low F village = < 0.5 mg/L

Controls for (1) Children included in study had normal birth history, were permanent Confounding residents in the region of study, had no history of trauma to the head, no Factors: history of chronic illness, not on medication. (2) Villages have similar culture, standard of living, and lifestyle habits.

Type of IQ Raven’s Colored Progressive Matrices Test Test

Results: (A) Children with dental fluorosis had lower IQ (66.63+18.09) than those without dental fluorosis (76.36+20.84), p < 0.05. (B) Children with mild dental fluorosis had lower IQ (66.73) than those without dental fluorosis (75.89), p < 0.05.

Conclusion: “Previous studies had indicated toward decreased Intelligence in children exposed to high levels of fluoride and our study also confirmed such an effect.”

IQ Study #29: Li (2009)

Citation: Li F, et al. (2009). The impact of endemic fluorosis caused by the burning of coal on the development of intelligence in children. Journal of Environmental Health 26(4):838-40.

Location of Xinhua County, Hunan Province, China study:

Submission No: 1064

Size of study: 80 children total: 20 children from “mild” fluorosis area, 20 from “medium” fluorosis area, 20 from “severe” fluorosis area, and 20 from non-fluorosis area.

Age of 8-12 years old Subjects:

Source of Coal burning Fluoride:

Fluoride Urine F (by region):severe = 2.34+1.13 mg/L exposure medium = 1.67+0.66 mg/L levels: mild = 1.24+0.43 mg/L control = 0.96+0.52 mg/LUrine F (by dental fluorosis type):

severe = 2.66+1.09 mg/L medium = 2.01+0.80 mg/L mild = 1.64+0.68 mg/L very mild = 1.17+0.48 mg/L suspected = 1.09+0.36 mg/L no fluorosis = 0.87+0.23 mg/L. Controls for (1) All children were born and raised in the respective areas. (2) Children Confounding were excluded if they had been diagnosed with physical deformation, Factors: developmental disorders, delayed mental development, emotional/behavioral obstacles or challenges, or other forms of mental disorders.

Type of IQ CRT-RC (Combined Raven’s Test for Rural China) Test

Results: - IQ decreased with increasing F level in urine (p < 0.01) – IQ was significantly reduced among children with severe fluorosis as compared to children without fluorosis (p < 0.05) – A trend (albeit not statistically significant) for IQ to decrease with increasing severity of dental fluorosis (NS) and with increasing severity of the region’s fluoride poisoning

Conclusion: “High exposure to fluoride most definitely has an adverse effect on the development of intelligence in children, in particular on the capability of abstract inference.”

IQ Study #28: Rocha-Amador (2007)

Citation: Rocha-Amador D, et al. (2007). Decreased intelligence in children and exposure to fluoride and arsenic in drinking water. Cadernos de Saude Publica 23(Suppl 4):S579-87.

Location of Durango State, Mexico & San Luis Potosi State, Mexico study:

Submission No: 1064

Size of study: 132 children

Age of 6 to 10 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride Lowest F village: 0.8+1.4 mg/L Levels Middle F village: 5.2+0.9 mg/L Highest F village: 9.4+0.9 mg/L

Urine Fluoride Lowest F village: 1.8+1.5 mg/L Levels Middle F village: 6.0+1.6 mg/L Highest F village: 5.5+3.3 mg/L

Controls for (1) A multiple regression analysis was used that controlled for blood lead Confounding levels, socioeconomic status, mother’s education, height-for-age (an index of Factors: malnutrition), and transferrin saturation. (2) Each child’s water fluoride level, and urine fluoride level, levels were individually determined. (3) The test examiner was blinded as to the children’s fluoride exposure.

IQ Test: Wechsler Intelligence Scale for Children–Revised Mexican Version (WISC- RM)

Results: (1) Both fluoride in urine, and fluoride in water, were significantly correlated with IQ, and this correlation remained significant after controlling for lead exposure, socioeconomic status, mother’s education, malnutrition, and transferrin. (2) Fluoride’s effect on IQ was larger than the effect from arsenic.

Conclusion: “We found that exposure to F in urine was associated with reduced Performance, Verbal and Full IQ scores before and after adjusting for confounders. The same pattern was observed for models with F in water as the exposure variable. . . . The individual effect of F in urine indicated that for each mg increase of F in urine a decrease of 1.7 points in Full IQ might be expected.”

IQ Study #27: Wang (2007)

Citation: Wang SX, et al. (2007). Arsenic and fluoride exposure in drinking water: children’s IQ and growth in Shanyin county, Shanxi province, China. Environmental Health Perspectives 115(4):643-7.

Location of Shanyin County, Shanxi Province, China study:

Size of study: 720 children: 21-196 per village (3 villages for each of the arsenic groups)

Submission No: 1064

Age of 8-12 years old Subjects:

Source of Water Fluoride:

Water Fluoride High-Arsenic group = 0.9+0.5 mg/L Levels: Medium-Arsenic group = 1.7+1.1 mg/L High-Fluoride group = 8.3+1.9 mg/L Control group = 0.5+0.2 mg/L

Urine Fluoride High-Arsenic group = 1.0+1.7 mg/L levels: Medium-Arsenic group = 2.8+1.9 mg/L High-Fluoride group = 5.1+2.0 mg/L Control group = 1.5+1.6 mg/L

Controls for (1) Arsenic used as variable. Similar manganese levels in water for all Confounding groups. (2) All groups lived in rural areas with similar geographic and cultural Factors: conditions and a comparable level of socioeconomic development (years of parental education, average income, years of exposure). (3) All children currently attending school.

Type of IQ CRT-RC (Combined Raven’s Test for Rural China) Test

Results: - Average IQ in high-arsenic area (95.1+16.6) is significantly lower than IQ in control area (104.8+14.7). p < 0.05 – The average IQ in high-fluoride area (100.5+15.8) is also significantly lower than average IQ in control area (104.8+14.7). p < 0.05 – Significantly more children with IQ lower than 70 (mental retardation) in high-F area (4%), medium-arsenic area (3.3%), and high-arsenic area (8.3%) as compared to control (0%).

Conclusion: “This study indicates that exposure to fluoride in drinking water is associated with neurotoxic effects in children.”

IQ Study #26: Trivedi (2007)

Citation: Trivedi MH, et al. (2007). Effect of high fluoride water on intelligence of school children in India. Fluoride 40(3):178-183.

Location of - High F area: Sachana, Sanand district, Gujarat, India – Medium F area: study: Chandlodia, Ahmedabad, India

Size of study: 190 children (89 in high F area; 101 in medium F area)

Age of 12-13 years old Subjects:

Submission No: 1064

Source of Water Fluoride:

Water Fluoride High F area=5.55+0.41 mg/L Levels: Medium F area=2.01+0.009 mg/L

Urine Fluoride High F area = 6.13+0.67 mg/L Levels: Medium F area = 2.30+0.28 mg/L

Controls for (1) The study included only those children who were life-long residents of the Confounding areas. respective location. (2) The areas have similar nutritional status and Factors: both have middle class socioeconomic status (although Sachana is slightly poorer). (3) Iodized salt is used in both areas.

Type of IQ Questionnaire prepared by Prof. JH Shah; standardized on the Gujarati Test population with 97% reliability rate in relation to the Stanford-Binet Intelligence Scale

Results: (A) Average IQ is lower in High-F area (91.72+1.13) than in Low-F area (104.44+1.23), p<0.001. (B) High F area has 28.09% of children with IQ below normal (over twice the percentage found in lower F area).

Conclusion: “In agreement with other studies elsewhere, these findings indicate that children drinking high F water are at risk for impaired development of intelligence.”

IQ Study #25: Fan (2007)

Citation: Fan Z, et al. (2007). The effect of high fluoride exposure on the level of intelligence in children. Journal of Environmental Health 24(10):802-03.

Location of Pucheng County, Shaanxi Province, China. study:

Size of study: 79 children (42 children in High F area; 37 children in low F area)

Age of 7-14 years old Subjects:

Source of Water Fluoride:

Water Fluoride - High F area=3.15 mg/L Levels: - Low F area=1.03 mg/L (water-improvement schemes implemented 14-18 years before study)

Urine Fluoride - High F area group=2.89+1.97 mg/L (range: 1.14-6.09 mg/L); Levels: - Low F area group=1.78+0.46 mg/L (range: 1.33-2.35 mg/L) (non-significant difference, likely because F is consumed from various sources other than

Submission No: 1064

water)

Controls for (1) The two areas have common habits and lifestyles in terms of cuisine, Confounding economy, culture, education, agricultural goods, etc.. (2) No chemical Factors: factories in area. (3) The area does not have an iodine deficiency problem.

Type of IQ CRT-C2 intelligence module Test

Results: (A) Average IQ in High-F area (96.11 + 12.00) is lower than Low-F area (98.41 + 14.75), although difference is not statistically significant. (B) No child in High-F area has outstanding or excellent intelligence. The respective rates in the Low-F area are 2.7% and 5.4%, respectively.

Conclusion: “Exposure to high levels of fluoride is likely to cause a certain level of harm to a child’s level of intelligence.”

IQ Study #24: Seraj (2006)

Citation: Seraj B, et al. (2006). [Effect of high fluoride concentration in drinking water on children’s intelligence]. [Study in Persian] Journal of Dental Medicine 19(2):80-86.

Location of Iran study:

Size of study: 126 children (85 children from low-F village, 41 children from high-F village)

Age of Not provided in English abstract (full study is in Persian) Subjects:

Source of Water Fluoride:

Water Fluoride High F village = 2.5 mg/L Levels: Low F village = 0.4 mg/L

Controls for The history of illnesses affecting the nervous system, head trauma, birth Confounding weight (>2.5kg or < 2.5kg), residental history, age and sex of children were Factors: investigated by questionnaires completed by the children’s parents.

Type of IQ Raven’s Test

Results: “In the high fluoride area the mean IQ of children (87.9±11) was significantly lower than in the low fluoride area (98.9±12.9) (P=0.025).”

Statistical ““Based on the findings of this study, exposure of children to high levels of significance fluoride may carry the risk of impaired development of intelligence.”

Submission No: 1064

IQ Study #23: Wang (2005)

Citation: Wang S, et al. (2005). The effects of endemic fluoride poisoning caused by coal burning on the physical development and intelligence of children. Journal of Applied Clinical Pediatrics 20(9):897-898 (republished in Fluoride 2008; 41:344-348).

Location of Zhijin County, Ghizhou Province, China study:

Size of study: 226 children (176 children in High F area, including 119 children with skeletal fluorosis and 57 children with only dental fluorosis; 50 children in low-F area without skeletal or dental fluorosis)

Age of 7-12 years old Subjects:

Type of Coal burning Exposure:

Urine Fluoride High F group=1.352+0.457 mg/L (n=144) Levels: Lower F group=1.611+0.467 mg/L (n=35)

Controls for (1) Both areas are free from iodine deficiency. (2) Both areas have similar Confounding standard of living, sanitation, culture, and availability of medical treatment. Factors:

Type of IQ Raven’s Standard Theoretical Intelligence Test, Chinese version Test

Results: Children from high F (endemic) areas had lower IQ than those from lower F (control) area (p<0.01). Negative correlation between urine F and IQ (p<0.01).

Conclusion: “High fluoride burden has a definite effect on the intellectual and physical development of children.”

IQ Study #22: Xiang (2003a,b)

Citation: - Xiang Q, et al. (2003a). Effect of fluoride in drinking water on children’s intelligence. Fluoride 36: 84-94. – Xiang Q, et al. (2003b). Blood lead of children in Wamiao-Xinhuai intelligence study. Fluoride 36: 198-199.

Location of Sihong County, Jiangsu Province, China study:

Submission No: 1064

Size of study: 512 children (222 children in high-F village, 290 children in low-F village)

Age of 8-13 years old Subjects:

Type of Water Exposure:

Water Fluoride High F village=2.47+0.79 mg/L (range=0.57-4.50 mg/L) Levels: Low F village=0.36+0.15 mg/L (range=0.18-0.76 mg/L)In the high-F village, children were subdivided into the following five fluoride water levels:Group A<1.0 mg/L; Group B=1.0-1.9 mg/L; Group C=2.0-2.9 mg/L; Group D=3.0-3.9 mg/L; Group E>3.9 mg/L.

Urine Fluoride High F village=3.47+1.95 mg/L Levels: Low F village=1.11+0.39 mg/L

Controls for (1) The two villages have similar urine iodine levels (p>0.3), and blood lead Confounding levels (p>0.48). (2) Neither village has fluoride pollution from burning coal or Factors: other industrial sources. (3) None of the residents reported drinking brick tea. (4) Children who had been absent from either village for 2 years or longer, or who had a history of brain disease or head injury were excluded from study.

Type of IQ CRT-RC (Combined Raven’s Test for Rural China) Test

Results: (A) Mean IQ of high F village (92.02+13.00) is lower than low F village (100.41+13.21), p<0.01. (B) Higher drinking water F is significantly associated with higher rates of mental retardation (IQ<70) and borderline intelligence (IQ=70-79), p<0.05. (C) Children’s IQs are not related to urinary iodine, family income, or parent’s education level.

Conclusion: “In endemic fluorosis areas, drinking water fluoride levels greater than 1.0 mg/L may adversely affect the development of children’s intelligence.”

IQ Study #21: Li (2003)

Citation: Li Y, et al. (2003). Effects of endemic fluoride poisoning on the intellectual development of children in Baotou. Chinese Journal of Public Health Management 19(4):337-338 (republished in Fluoride 2008; 41:161-64).

Location of Baotou, Inner Mongolia, China study:

Size of study: 936 children (720 children from high-F endemic area; 236 children from low-

Submission No: 1064

F control area)

Age of 6-13 years old Subjects:

Source of F Water exposure:

Fluoride “The region classified as endemic was designated using the 1981 standards exposure for designation of endemic regions laid out in 1981’s Standards for Endemic levels: Fluorosis Prevention and Treatment Work”

Controls for None given. Confounding Factors:

Type of IQ Illustrated version of the Chinese Standardized Raven Test for children in Test rural areas

Results: (A) Average IQ of children in endemic area (92.07) somewhat lower than that of control area (93.78), NS. (B) Rate of children with low IQ (<69) greater in endemic area (10.38%) than in control area (4.24%) (“high statistical significance”, but no p value given).

Conclusion: “In our study, we found that the average IQ of children in a fluoride endemic area was somewhat lower than the control, but the result was not statistically significant (p > 0.05). The percentage of children with fluorosis, however, was higher as compared to the control, and this was very significant statistically.”

IQ Study #20: Shao (2003)

Citation: Shao Q, et al. (2003). Study of cognitive function impairment caused by chronic fluorosis. Chinese Journal of Endemiology 22(4):336-38.

Location of Bijie City (high F area) and Tongren area (control area), Guizhou Province, study: China

Size of study: 88 adults (49 adults in High-F area; 39 adults in Low-F area)

Age of Aged 30-50 (High-F area = 42+6 years; Low-F area = 43+6 years) Subjects:

Source of Water Fluoride Exposure:

Fluoride Adults in high-F area diagnosed as suffering from fluoride poisoning (as exposure

Submission No: 1064

levels: evident by dental and skeletal changes). Water F levels not provided.

Controls for Non-iodine deficient areas. Exclusions of mental disorders caused by mental Confounding retardation, brain organic and somatic diseases. All farmers. Similar Factors: distribution of age, sex, education level.

Type of IQ Wechsler Adult Intelligence Scale test for Rural China (WATS-RC); Test Associated learning (AL) test; Digit Span (DS) test; Similarity test; Speech fluency test (SFT); Comprehension test.

Results: (A) Significantly lower operation score on IQ test in high F area (48-54) versus low F area (52-59), p < 0.01. (B) Lower total IQ score in high F area (78-100, average) than in low F area (109-118, average-high), although not statistically significant (C) High F subjects have significantly lower scores on several of the performance tests (speech fluency, recognition, similarity, p < 0.01, and digit span, p < 0.05), and this correlates with elevated levels of oxidative stress.

Conclusion: “The results suggest that some cognitive function limitations exist in those suffering from chronic fluoride poisoning, and its biologic basis may be related to the levels of SOD and NO [indices of oxidative stress].”

IQ Study #19: Wang (2001)

Citation: Wang X, et al. (2001). Effects of high iodine and high fluorine on children’s intelligence and thyroid function. Chinese Journal of Endemiology 20(4):288- 90.

Location of Binzhou and Dezhou, Qingyun County, Shandong Province, China study:

Size of study: 513 children (322 children from school in high iodine/high fluoride area; 193 children from school in lower iodine/lower fluoride area).

Age of 8-12 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride - High iodine/high fluoride area=2.97 mg/L – Lower iodine/lower fluoride Levels: area=0.5 mg/L

Urine Fluoride - High iodine/high fluoride = 3.08+1.03 mg/L – Low iodine/low fluoride = Levels: 0.82+0.56 mg/L

Controls for Iodine exposure. Confounding

100

Submission No: 1064

Factors:

Type of IQ CRT-RC (Combined Raven’s Test for Rural China) Test

Results: (A) Average IQ is lower in High-F area than in Low-F area (76.67+7.75 vs. 81.67+11.97), although the difference does not reach statistical significance. (B) The rate of extremely low and borderline IQ is higher in the High F areas than in the Low F areas (16.67% vs. 10% and 36.67% vs. 16.67, respectively), although these differencese do not reach statistical significance.

Conclusion: “High iodine and high fluorine have certain influence on children’s intelligence and thyroid function.”

IQ Study #18: Hong (2001)

Citation: Hong F, et al. (2001). Research on the effects of fluoride on child intellectual development under different environments. Chinese Primary Health Care 15(3):56-57 (republished in Fluoride 2008; 41(2):156–60).

Location of Wukang, Boxing, and Zouping counties, Shangdong Province, China study:

Size of study: 205 children (32 controls; 85 High F; 32 High-F/High Iodine; 28 High F/Low Iodine; 28 Low F/Low Iodine)

Age of 8-14 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride - Control area = 0.75 mg/L – High F only = 2.90 mg/L – High F/High I = 2.85 Levels: mg/L – High F/Low I = 2.94 mg/L – Low F/Low I = 0.48 mg/L

Controls for - Iodine exposure. – Areas have same geographical features and standard of Confounding living. Factors:

Type of IQ Chinese Standardized Raven’s Test for Rural areas (CRT-R) Test

Results: (A) Average IQ of High F/Low I group (68.38+19.12) and Low F/Low I group (75.53+6.92) is lower than control group (82.79+8.98), p<0.01. (B) IQ of High F/Low I group is lower than Low F/Low I group, p<0.01. (C) Significant interaction exists between High Fluoride and Low Iodine, p<0.01. (D) IQ ranking of high F groups show significant deficits compared to control,

101

Submission No: 1064

p<0.01.

Conclusion: “The IQ results of this study show no significant difference between the average IQs of those children from the high fluoride only areas and the high fluoride/high iodine areas, however the result from the high fluoride/low iodine group show statistically significant differences as compared to that of the low fluoride/low iodine group. In short, it appears that the presence or lack of iodine is a more significant factor in both the prevalence of goiter and average IQ.”

IQ Study #17: Lu (2000)

Citation: Lu Y, et al (2000). Effect of high-fluoride water on intelligence of children. Fluoride 33:74-78.

Location of Tianjin Xiqing District, China study:

Size of study: 118 children (60 children in High-F village; 58 children in Low-F village)

Age of 10-12 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride - High F village = 3.15+0.61 mg/L – Low F village = 0.37+0.04 mg/L Levels:

Urine Fluoride - High F village = 4.99+2.57 mg/L – Low F village = 1.43+0.64 mg/L Levels:

Controls for (1) Children included in the study are lifelong residents of study area. (2) Confounding Villages have similar population size, social, economic and educational Factors: backgrounds. (3) Children with congenital or acquired neurological disorders were excluded.

Type of IQ Chinese Combined Raven’s Test, Copyright 2 (CRT-C2) Test

Results: (A) Average IQ of children from High F village (92.27+20.45) is lower than children from Low F village (103.05+13.86), p<0.005. (B) More “retarded” (IQ=<70) and “borderline” intelligence (IQ=70-79) children in high F group (21.6%) than in low F group (3.4%), p<0.005. (C) Significant inverse relationship exists between urinary F and IQ.

Conclusion: “The findings of this study thus replicate those of earlier studies and suggest

102

Submission No: 1064

that a real relationship exists between fluoride exposure and intelligence.”

IQ Study #16: Zhang (1998)

Citation: Zhang J, et al. (1998). The effect of high levels of arsenic and fluoride on the development of children’s intelligence. Chinese Journal of Public Health 17(2):119.

Location of Kuitun region, Urumqi, China Study:

Size of Study: 164 children

Age of 4-10 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride For the 4 to 8 year olds, the fluoride level their entire life (including during Levels: fetal development) was between 0.49 and 0.81 ppm. The 9 year olds were exposed to high fluoride (level not provided) during fetal development. The 10 year olds were exposed to high fluoride during fetal development and their first year of life.

Controls for Arsenic level in water. Confounding Factors:

Type of IQ 50-point evaluation tests created by Japanese researcher, Shigeo Kobayashi Test:

Results: No difference in IQ among the 4 to 8 year olds, a slight (non-significant) reduction in IQ among the 9 year olds (who were exposed to fluoride during fetal development), and a significant reduction among the 10 year olds (who were exposed during fetal development and their first year of life).

Conclusion: “Even though there were differences in the results from the 10 year-old subjects from the normal comparative group, in contrast to subjects from the high fluoride high arsenic group and the high fluoride group, these results might not be overtly representative as less number of subjects from the high fluoride group has been tested.”

IQ Study #15: Yao (1997)

103

Submission No: 1064

Citation: Yao Y, et al. (1997). Comparative assessment of the physical and mental development of children in endemic fluorosis area with water improvement and without water improvement. Literature and Information on Preventive Medicine 3(1):42-43.

Location of Chaoyang City, Liaoning Province, China study:

Size of study: 823 children (326 children from fluorosis area with water improvement; 183 children from fluorosis area without water improvement; 314 children from non-fluorosis area)

Age of 7-14 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride - Fluorosis area without water improvements = 2.0 mg/L- Fluorosis with water Levels: improvements = 0.33 mg/L (prior to improvement 8 years before study, the F level was 2.0 mg/L)- Non-fluorosis area = 0.4 mg/L

Controls for - All children born locally.- Areas in study have adequate iodine exposure Confounding and similar levels of economic development, living conditions, school size, Factors: and number of teachers.

Type of IQ CRT-RC (Combined Raven’s Test for Rural China) Test

Results: (A) Children in fluorosis area (without water improvement) have lower average IQ than children in fluorosis area (with water improvement) for all age groups, p<0.01. (B) Children in fluorosis area without water improvement have lower average IQ than children in non-fluorosis area for all age groups, p<0.01. (C) Children born prior to water improvement program in fluorosis area with water improvement have lower average IQ than children in non- fluorosis area, p<0.05. (D) No significant difference in intelligence exists between children born after water improvement and children in non-fluorosis area.

Conclusion: “These results show that water improvement and defluoridation can improve the mental and physical development of children in a fluorosis area.“

IQ Study #14: Yao (1996)

Citation: Yao Y, et al. (1996). Analysis on TSH and intelligence level of children with dental Fluorosis in a high fluoride area. Literature and Information on Preventive Medicine 2(1):26-27.

104

Submission No: 1064

Location of Chaoyang City, Liaoning Province, China study:

Size of study: 536 children (78 children from high-fluorosis area; 188 children from light- fluorosis area; 270 children from non-fluorosis area)

Age of 8-12 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride High-F area: <11 mg/L Low-F area: 2.0 mg/L Control area: 1.0 mg/L Levels:

Controls for (1) Children in each of the three areas have adequate iodine exposure as Confounding determined through urine analysis. (2) The three areas have similar Factors: economic development, schools, and teachers.

Type of IQ Raven test—Associative Atlas (Version of Chinese village) Test

Results: (A) Average IQ of children with dental fluorosis in high-fluorosis area and light-fluorosis areas is lower than children in non-fluorosis area, p<0.01. (B) Average IQ of children with dental fluorosis from high-fluorosis area is lower than those from light-fluorosis area, p<0.05. (C) Rate of high IQ (>120) is lower in high-fluorosis area (3.85%) and light-fluorosis area group (6.91%) than non-fluorosis area (10.74%) (no p value given).

Conclusion: “The results of the intelligence tests show that a high level of fluoride influences children’s IQ, which is consistent with some previous data. It is worth mentioning that the higher the degree of dental fluorosis, the more negative the impact on the children’s intelligence level. This is an issue which merits utmost attention.”

IQ Study #13: Zhao (1996)

Citation: Zhao LB, et al (1996). Effect of high-fluoride water supply on children’s intelligence. Fluoride 29: 190-192.

Location of Shanxi Province, China study:

Size of study: 320 children (160 children from high-F village; 160 children from lower-F village)

Age of 7-14 years old

105

Submission No: 1064

Subjects:

Source of Water Fluoride Exposure:

Water Fluoride High-F village = 4.12 mg/L Lower-F village = 0.91 mg/L Levels:

Controls for (1) Similar occupations, living standards, and social customs in the two Confounding villages. (2) Only children whose mothers lived in the village during Factors: pregnancy were included in study. (3) Parents’ educational level was determined (and found to have a significant influence on IQ, p < 0.01).

Type of IQ “Official intelligence quotient (IQ) tests lasting 40 minutes” Test

Results: Children in High-F village have significantly lower average IQ (97.69+13.00) than children in lower-F village (105.21+14.99), p<0.01.

Conclusion: “The results of this study indicate that intake of high-fluoride drinking water from before birth has a significant deleterious influence on children’s IQ in one of two similar villages.”

IQ Study #12: Wang (1996)

Citation: Wang G, et al. (1996). A study of the IQ levels of four- to seven-year-old children in high fluoride areas. Endemic Diseases Bulletin 11(1):60-6 (republished in Fluoride 2008; 41:340–43).

Location of Shehezi, Xinjiang Province, China study:

Size of study: 230 children (147 children from High-F village; 83 children from Low-F village)

Age of 4-7 years old Subjects:

Source of Water & Coal-Burning Fluoride Exposure:

Water Fluoride - All wells = 0.58-8.60 mg/L – High F area = > 1.0 mg/L – Low F area = < 1.0 Levels: mg/L

Controls for (1) Children were excluded from study if they had a low intellectual ability due Confounding to genetic inheritance, past illness, malnutrition, uses of medication, or other reasons. (2) “Significantly greater” percentage of children with below average

106

Submission No: 1064

Factors: head circumference in High F area (18.37%) than in Control area (9.64%) (no p value given).

Type of IQ Wechler Preschool and Primary Scale of Intelligence (WPPSI) Test

Results: (A) Average Total IQ in High F group (95.64+14.34) is lower than in control group (101.23+15.84), p<0.05. (B) Average Performance IQ in High F group (94.33+14.76) is lower than in Control group (101.77+18.12), p<0.01. (C) Average Verbal IQ is not significantly different. (D) In High F area, children with below-normal head circumference have lower average IQ (89.07+15.69) than those with normal head circumference (97.13+8.06), p<0.01.

Conclusion “The results show that a high fluoride intake has a clear influence on the IQ of preschool children, manifesting itself primarily as damage to performance intelligence.”

IQ Study #11: Li (1995)

Citation: Li XS. (1995). Effect of fluoride exposure on intelligence in children. Fluoride 28:189-192.

Location of Anshu and Zhijin counties, Guizhou Province, China study:

Size of study: 907 children (230 children from severe fluorosis area; 224 children from medium fluorosis area; 227 children from slight fluorosis area; 226 children from non-fluorosis area)

Age of 8-13 years old Subjects:

Source of Coal burning Fluoride Exposure:

Urine Fluoride - Severe dental fluorosis = 2.69 mg/L – Medium dental fluorosis = 2.01 mg/L Levels – Slight dental fluorosis = 1.81 mg/L – No dental fluorosis = 1.02 mg/L

Controls for (1) All children of Han nationality.(2) Children were excluded from study if Confounding they had congenital or acquired diseases “not related to fluoride.” (3) Groups Factors: separated by intervals of 6 months in age.

Type of IQ China Rui Wen’s Scaler for Rural Areas Test

Results: Average IQ of children in severe (80.3+12.9) and medium (79.7+12.7) fluorosis areas is lower than the slight (89.7+12.7) and non-fluorosis

107

Submission No: 1064

(89.9+10.4) areas, p<0.01.

Conclusion: “A high fluoride intake was associated with a lower intelligence.”

IQ Study #10: Xu (1994)

Citation: Xu Y, et al. (1994). The effect of fluorine on the level of intelligence in children. Endemic Diseases Bulletin 9(2):83-84.

Location of Shandong Province, China study:

Size of study: 330 children (8 groups of 21-97 children categorized based on fluoride and iodine content of water)

Age of 8-14 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride - High Fluoride/High Iodine = 3.9 mg/L – High Fluoride/Low Iodine = 2.0 mg/L Levels: – High Fluoride = 1.8 mg/L – Low Fluoride = 0.38-0.5 mg/L – Control Area = 0.8 mg/L

Controls for (1) Water iodine level used as variable. (2) Child’s pre-school education Confounding history was determined. (3) Parent’s literacy was determined. Factors:

Type of IQ Bient-Siman Test

Results: (A) Children in areas with high-fluoride and low-iodine have significantly lower IQs than children in areas with high-fluoride and high-iodine, p < 0.01. (B) More children have low IQ (< 69) in areas with High F/High I (10.53%), High F only (7.32%), and High F/Low I (12.82%) than in control group (1.61%)

Conclusion: “The number of children whose level of intelligence is lower is significantly increased in regions of high fluoride/iodine, regions of high fluoride only, regions of high fluoride/low iodine, against their respective comparative groups. . . . This could be demonstrative of the fact that fluoride acts to increase the toxicity and worsen the occurrence of thyroid swelling.”

IQ Study #9: Li (1994)

108

Submission No: 1064

Citation: Li Y, et al. (1994). Effects of high fluoride intake on child mental work capacity: Preliminary investigation into the mechanisms involved. Journal of West China University of Medical Sciences 25(2):188-91 (republished in Fluoride 2008; 41:331-35).

Location of Sichuan Province, China study:

Size of study: 158 children from two neighboring townships (107 children with various degrees of dental fluorosis; 51 children with no dental fluorosis)

Age of 12-13 years old Subjects:

Source of Food contaminated by coal smoke Fluoride Exposure:

Fluoride - Children with no dental fluorosis = 0.5 mg/kg- Children with dental fluorosis Content of (HiF1) = 4.7 mg/kg- Children with dental fluorosis (HiF2) = 5.2 mg/kg- Grain: Children with dental fluorosis (HiF3) = 31.6 mg/kg

Controls for (1) The areas have similar levels of fluoride in water (0.3 mg/L) and air (0.02- Confounding 0.51 mg/m3) and similar levels of zinc in soil. (2) The areas townships have Factors: similar economic and cultural status, lifestyle, dietary habits, basic constituents of food. (3) Age, gender, and grade level of the children are kept “as constant as possible.” (4) Children with acute or chronic diseases not related to fluoride were excluded from study.

Type of IQ Mental Work Capacity determined by number of letters found (NLF), rate of Test error (RE), index of mental capacity (IMC), short-term memory capacity (SMC), visual reaction time (RT).

Results: (A) Children with dental fluorosis in mid-exposure group (HiF2) have reduced short-term mental capacity (p<0.05), reduced mental capacity index (p < 0.01), and reduced NLF scores (p<0.01) as compared to children with no fluorosis and children with lower exposure.(B) Children with dental fluorosis in high-exposure group (HiF3) have reduced short-term mental capacity (p<0.01), reduced mental capacity index (p < 0.01), and reduced NLF scores (p<0.01) as compared children with no fluorosis and children with low exposure.

Conclusion: “As shown in this study, the mental work capacity (MWC) of the two groups of children with grade 3 dental fluorosis was lower than the two groups with no dental fluorosis. . . . This indicates that early, long-term exposure to excess fluoride causes deficits in memory, attention, and reaction time, but 12–13 year-old children with only recent exposure show no major effects. Studies [on human fetuses] have already shown that the developing brain is one of the ripest targets for disruption by fluoride poisoning. Given that before six years of age the human brain is in its fastest stage of

109

Submission No: 1064

development, and that around seven and eight basic structural development is completed, therefore the brain is most vulnerable to damage from excess fluoride intake before this age.”

IQ Study #8: Yang (1994)

Citation: Yang Y, et al. (1994). The effects of high levels of fluoride and iodine on intellectual ability and the metabolism of fluoride and iodine. Chinese Journal of Epidemiology 15(4):296-98 (republished in Fluoride 2008; 41:336-339).

Location of Shandong Province, China study:

Size of study: 60 children (30 from high-F village, 30 from Low-F village)

Age of 8-14 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride High F/High Iodine area = 2.97 mg/L Control area = 0.5 mg/L Levels:

Urine Fluoride High F/High Iodine area = 2.08+1.03 mg/L Control area = 0.82+0.56 mg/L Levels:

Controls for (1) Iodine exposure. (2) Areas are in close proximity to each other. Confounding Factors:

Type of IQ Chinese Comparative Scale of Intelligence Test Test

Results: (A) Children in high F/high iodine area have lower IQ (76.67+7.75) than those in low F area (81.67+11.97), although the difference is not statistically significant.(B) Greater percentage of children have moderately low IQ (<79) in High F/High Iodine area (76.67%) than in control area (36.67%), p<0.01.

Conclusion: “An excess of fluoride and a lack of iodine in the same environment has been shown to have a marked effect on child intellectual development, causing a more significant intellectual deficit than lack of iodine alone.”

IQ Study #7: An (1992)

110

Submission No: 1064

Citation: An J, et al. (1992). The effects of high fluoride on the level of intelligence of primary and secondary students. Chinese Journal of Control of Endemic Diseases 7(2):93-94.

Location of Xingshunxi Town, Guyang County, Inner Mongolia (4 neighboring villages study: with high fluoride centered around Wubu Ziyao village and 6 neighboring villages with lower fluoride centered around Hada Heshao Village).

Size of study: 242 children (121 children from high-F villages and 121 children from the low-F villages)

Age of 7-16 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride High-F villages = 2.1+7.6 mg/L Control villages = 0.6+1.0 mg/L Levels:

Controls for (1) Dental fluorosis rates were determined in both areas (90.9% in High-F Confounding area vs. 21.5% in Low-F area). (B) Both areas are in the countryside, are 15 Factors: km from each other, and share the same Han ethnicity. (C) The geography, culture, education, living standard, and social economic conditions are “very similar.”

IQ Test: Wechsler Intelligence Scale for Children

Results: (A) Children in the High-F villages have significantly lower IQs at each age group studied: 7-10 (p < 0.02); 11-13 (p < 0.01); 14-16 (p < 0.03); 7-16 (p < 0.01). (B) Significantly more children in High-F villages have “critical state” IQ, p < 0.01. (C) When children within the High-F villages are stratified into highest-F (5.2-7.6 mg/L), and lowest-F levels (2.1-3.2 mg/L), the children in the higher-F areas had significantly lower IQ than the lower-F areas (p < 0.05).

Conclusion “The results show that the level of intelligence of primary and secondary students from the high fluoride area and that of primary and secondary students from the non-high fluoride area had very significant differences, proving that high fluoride has adverse effects on the mental development of students. The higher the water fluoride is, the lower the level of IQ.”

IQ Study #6: Lin (1991)

Citation: Lin Fa-Fu; et al (1991). The relationship of a low-iodine and high-fluoride environment to subclinical cretinism in Xinjiang. Endemic Disease Bulletin 6(2):62-67 (republished in Iodine Deficiency Disorder Newsletter Vol. 7(3):24-

111

Submission No: 1064

25).

Location of Hetian prefecture, Xinjiang, China study:

Size of study: 749 children (250 children in High-F/Low Iodine area; 256 children in Low- F/Low-Iodine area; and 243 children in Low F/Low Iodine area)

Age of 7-14 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride High F/Low Iodine = 0.88 mg/L Low F/Low Iodine = 0.34 mg/L Control area = Levels: n/a

Urine Fluoride High F/Low Iodine = 2.56 mg/L Low F/Low Iodine = 1.34-1.61 mg/L Control Levels: area = 1.6 mg/L

Controls for (1) Iodine exposure. (2) Lower socioeconomic status in all areas. (3) Areas Confounding have similar nationalities, habits, customs, and income. Factors:

IQ Test: CRT-RC (Combined Raven’s Test for Rural China)

Results: Children from the High F/Low Iodine area have significantly lower IQs (IQ=71) than children from the Low F/Low Iodine area (IQ=77-79; p<0.05), and control area (IQ=96); p<0.01).

Conclusion: “The significant differences in IQ among these regions suggests that fluoride can exacerbate central nervous lesions and somatic developmental disturbance caused by iodine deficiency.”

IQ Study #5: Guo (1991)

Citation: Guo X, et al. (1991). A preliminary investigation of the IQs of 7-13 year old children from an area with coal burning-related fluoride poisoning. Chinese Journal of Endemiology 10(2):98-100 (republished in Fluoride 2008; 41(2):125–28).

Location of Xinshao County, Hunan Province, China study:

Size of study: 121 children (60 children with mild to severe fluorosis from an endemic area where coal is used as a fuel source; 61 children from a non-endemic area where wood is used as a fuel source)

112

Submission No: 1064

Age of 7 to 13 years old Subjects:

Source of Coal burning (Fluoride levels in water < 0.5 mg/l in both areas) Fluoride Exposure:

Blood Fluoride Endemic area=0.1483+0.0473 mg/L Non-endemic area=0.1044+0.0652 Levels: mg/L (p<0.01)

Controls for The two areas are neighboring townships with “very similar” economies, Confounding cultures, living standards, lifestyles, public health, and education. Factors:

IQ Test: Chinese Binet IQ Test

Results: (A) Children from endemic fluorosis area have lower average IQ (76.7) than children in non-endemic area (81.4), p<0.05. (B) A greater percentage (30%) of children in endemic area have low IQ (<69) than in non-endemic area (11.5%), p<0.05.

Conclusion: ”In summary, although diminished intellectual ability can result from a multitude of factors (both innate and acquired) that influence neural development and cell division in the cerebrum, the comparison conducted in this study of two areas where the other environment factors are basically the same shows clear differences in IQ, and it [is] probable that this difference is due to a high fluoride environment.”

IQ Study #4: Chen (1991)

Citation: Chen YX, et al. (1991). Research on the intellectual development of children in high fluoride areas. Chinese Journal of Control of Endemic Diseases 6(Suppl):99-100 (republished in Fluoride 2008; 41:120–24).

Location of Linyi County, Shanxi Province, China study:

Size of study: 640 children (320 children from High-F village; 320 children from Lower-F village)

Age of 7 to 14 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride High-F village = 4.55 mg/L Lower-F village = 0.89 mg/L

113

Submission No: 1064

Levels:

Controls for The occupations, culture, standard of living, lifestyle habits, access to health Confounding and transportation facilities are “essentially the same” between the two Factors: areas.

IQ Test: Rural version of Chinese Standardized Raven Test

Results: Average IQ of children in High-F village (100.24+14.52) significantly lower than children in lower-F village (104.03+14.96), p<0.01.

Conclusion: “The results of this study indicate that there is significant difference between the intellectual ability of the 7–14 year old children from the [fluorosis] endemic area and those of the control, and moreover that the average IQ of the children from the endemic area is clearly lower.”

IQ Study #3: Sun (1991)

Citation: Sun M, et al. (1991). Measurement of intelligence by drawing test among the children in the endemic area of Al-F combined toxicosis. Journal of Guiyang Medical College 16(3):204-06.

Location of Guizhou Province, China: Liupanshui City (endemic fluorosis area) and study: Guiyang City (non-endemic area)

Size of study: 420 children (196 children from endemic fluorosis area; 224 children from non-endemic area)

Age of 6.5-12 years old Subjects:

Source of N/A Fluoride Exposure:

Fluoride N/A exposure levels:

Controls for (1) Majority of children of farmers. (2) Children with bone and joint confounding deformities or nervous system symptoms were excluded from study. factors:

IQ Test: Drawing test for children (Japanese researcher’s Shigeo Kobayashi’s 50- point scoring method).

Results: Children from endemic fluorosis area had lower IQ than those from non- endemic area at all ages except <7 (p < 0.05)

114

Submission No: 1064

Excerpt: ”From these results, it can be concluded that excessive consumption of fluorine and aluminum in the early stage of development directly impacts the development of the human brain, which causes the delayed intellectual development seen in children living in the endemic areas.”

IQ Study #2: Qin (1990)

Citation: Qin LS, Cui SY. (1990). Using the Raven’s standard progressive matrices to determine the effects of the level of fluoride in drinking water on the intellectual ability of school-age children. Chinese Journal of the Control of Endemic Diseases 5(4):203-04 (republished in Fluoride 2008; 41:115–19).

Location of Jing County, Hubei Province, China study:

Size of study: 447 children (141 children from High-F area; 159 children from “normal” F area; 147 children from low-F area)

Age of 9 to 10.5 years old Subjects:

Source of Water Fluoride Exposure:

Water Fluoride High F = 2.1-4.0 mg/L“Normal” F = 0.5-1.0 mg/LLow F = 0.1-0.2 mg/L Levels:

Controls for All children had grown up drinking well water in their home village. confounding factors:

IQ Test: Raven’s Standard Progressive Matrices

Results: Children in High F (21.17%) and Low F (23.03%) areas had lower average IQ scores than children in normal F area (28.14%), p<0.01.

Conclusion: “All of these finding serve to indicate that both high and low fluoride can affect the normal development and function of the cerebrum as well as the entire nervous system causing a decrease in intellectual ability.”

IQ Study #1: Ren (1989)

Citation: Ren D, et al. (1989). A study of the intellectual ability of 8-14 year-old children in high fluoride, low iodine areas. Chinese Journal of Control of Endemic Diseases 4(4):251 (republished in Fluoride 2008; 41:319-20).

115

Submission No: 1064

Location of Shandong Province, China study:

Size of study: 329 children (160 children in High F/low Iodine area: 169 children in Low- F/Low Iodine area)

Age of 8 to 14 years old Subjects:

Source of Water Fluoride Exposure:

Fluoride N/A exposure levels:

Controls for Both study groups had low iodine intake. confounding factors:

IQ Test: Wechsler Intelligence Test

Results: - Average IQ of children in the High Fluoride/Low Iodine group (IQ=64.8) significantly lower than the children in the Low Fluoride/Low Iodine group (IQ = 85.0), p<0.01.- The percentage of children with low IQ (<69) significantly greater in High F/Low Iodine group (40.6%) than in Low Fluoride/Low Iodine group (13.6%), p<0.01.

Conclusion: “From the results it is evident that disrupted child intellectual development is among the effects on the human body from a harmful environment containing both high fluoride and low iodine, and this disruption is clearly much more serious than the effects of iodine deficiency alone.”

(New Zealand) Institute of Directors. (IoD) https://www.iod.org.nz/default.aspx

116

Submission No: 1064

http://www.parliament.nz/en- NZ/PB/Legislation/Bills/b/c/8/00DBHOH_BILL11034_1-Natural-Health-and- Supplementary-Products-Bill.htm

http://en.wikipedia.org/wiki/Nuclear_and_radiation_accidents Nuclear and radiation accidents

From Wikipedia.

A nuclear and radiation accident is defined by the International Atomic Energy Agency as "an event that has led to significant consequences to people, the environment or the facility." Examples include lethal effects to individuals, large radioactivity release to the environment, or reactor core melt."[2] The prime example of a "major nuclear accident" is one in which a reactor core is damaged and significant amounts of radioactivity are released, such as in the Chernobyl Disaster in 1986.

The impact of nuclear accidents has been a topic of debate practically since the first nuclear reactors were constructed. It has also been a key factor in public concern about nuclear facilities.[3] Some technical measures to reduce the risk of accidents or to minimize the amount of radioactivity released to the environment have been adopted. Despite the use of such measures, "there have been many accidents with varying impacts as well near misses and incidents".[3][4]

Benjamin K. Sovacool has reported that worldwide there have been 99 accidents at nuclear power plants.[5] Fifty-seven accidents have occurred since the Chernobyl disaster, and 57% (56 out of 99) of all nuclear-related accidents have occurred in the USA.[5] Serious nuclear power plant accidents include the Fukushima Daiichi nuclear disaster (2011), Chernobyl disaster (1986), Three Mile Island accident (1979), and

117

Submission No: 1064

the SL-1 accident (1961).[6] Stuart Arm states, "apart from Chernobyl, no nuclear workers or members of the public have ever died as a result of exposure to radiation due to a commercial nuclear reactor incident."[7]

Nuclear-powered submarine mishaps include the K-19 reactor accident (1961),[8] the K-27 reactor accident (1968),[9] and the K-431 reactor accident (1985).[6] Serious radiation accidents include the Kyshtym disaster, Windscale fire, radiotherapy accident in Costa Rica,[10] radiotherapy accident in Zaragoza,[11] radiation accident in Morocco,[12] Goiania accident,[13] radiation accident in Mexico City, radiotherapy unit accident in Thailand,[14] and the Mayapuri radiological accident in India.[14]

The International Atomic Energy Agency maintains a website reporting recent accidents.[15]

118